Healthcare Provider Details

I. General information

NPI: 1871429274
Provider Name (Legal Business Name): MAVIS LUZ ROJAS PARRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAVIS LUS MANN-ROJAS

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CONSTITUTION DR APT 302
MENLO PARK CA
94025-1178
US

IV. Provider business mailing address

110 CONSTITUTION DR APT 302
MENLO PARK CA
94025-1178
US

V. Phone/Fax

Practice location:
  • Phone: 574-239-5438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451021920
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: