Provider Demographics
NPI:1871084376
Name:ROA, RITA
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:ROA
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 1:6614 AVENUE U UNIT 789
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6021
Mailing Address - Country:US
Mailing Address - Phone:916-612-7829
Mailing Address - Fax:
Practice Address - Street 1:1037 DUNDAS ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-2610
Practice Address - Country:US
Practice Address - Phone:916-612-7829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst