Provider Demographics
NPI:1295350148
Name:ARANGO DORESTE, ROXANA
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:ARANGO DORESTE
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 1:12430 SW 217TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-2808
Mailing Address - Country:US
Mailing Address - Phone:305-281-5914
Mailing Address - Fax:
Practice Address - Street 1:12430 SW 217TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-2808
Practice Address - Country:US
Practice Address - Phone:305-281-5914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-120989106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician