Healthcare Provider Details

I. General information

NPI: 1164084992
Provider Name (Legal Business Name): MAYLEN SORIS ROCA BCABA 0-19-9522
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 SW 88TH ST # 285
MIAMI FL
33186-1515
US

IV. Provider business mailing address

9711 FONTAINEBLEAU BLVD
MIAMI FL
33172-4089
US

V. Phone/Fax

Practice location:
  • Phone: 786-399-9058
  • Fax:
Mailing address:
  • Phone: 786-399-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-19-9522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: