Provider Demographics
NPI:1487856043
Name:ROJO, MARITES OLIVA
Entity type:Individual
Prefix:
First Name:MARITES
Middle Name:OLIVA
Last Name:ROJO
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 1:3401 W DEL MONTE DR
Mailing Address - Street 2:22
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1463
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3401 W DEL MONTE DR
Practice Address - Street 2:22
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1463
Practice Address - Country:US
Practice Address - Phone:714-624-5228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT6581171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA5424211OtherDRIVERS LICENSE