Provider Demographics
NPI:1649505520
Name:ROJA, JOSUE ISAIAS (LDO)
Entity type:Individual
Prefix:
First Name:JOSUE
Middle Name:ISAIAS
Last Name:ROJA
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 NW 36TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6625
Mailing Address - Country:US
Mailing Address - Phone:305-202-1600
Mailing Address - Fax:305-717-1558
Practice Address - Street 1:8025 NW 36TH ST STE 300
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6625
Practice Address - Country:US
Practice Address - Phone:305-202-1600
Practice Address - Fax:305-717-1558
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 3905156FC0800X, 156FX1101X, 156FX1202X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001352000Medicaid