Healthcare Provider Details

I. General information

NPI: 1760020820
Provider Name (Legal Business Name): MIMI ROH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 MAITLAND SUMMIT BLVD
ORLANDO FL
32810-5915
US

IV. Provider business mailing address

907 OUTER RD STE B
ORLANDO FL
32814-6601
US

V. Phone/Fax

Practice location:
  • Phone: 866-311-4617
  • Fax: 407-965-4480
Mailing address:
  • Phone: 407-217-1401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: