Provider Demographics
NPI:1295344158
Name:TRUJILLO ROQUE, NAYVIS
Entity type:Individual
Prefix:
First Name:NAYVIS
Middle Name:
Last Name:TRUJILLO ROQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6217 SW 128TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5461
Mailing Address - Country:US
Mailing Address - Phone:786-816-8248
Mailing Address - Fax:
Practice Address - Street 1:6217 SW 128TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5461
Practice Address - Country:US
Practice Address - Phone:786-816-8248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT20128629106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician