Provider Demographics
NPI:1023107992
Name:ROTROCK, SUZETTE MARIA (MSLD/N)
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:MARIA
Last Name:ROTROCK
Suffix:
Gender:F
Credentials:MSLD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12966 SW 135TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7022
Mailing Address - Country:US
Mailing Address - Phone:305-298-4422
Mailing Address - Fax:
Practice Address - Street 1:12966 SW 135TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7022
Practice Address - Country:US
Practice Address - Phone:305-298-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 4294133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education