Healthcare Provider Details

I. General information

NPI: 1215858816
Provider Name (Legal Business Name): VIVIAN ROSE ROJAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10405 OSO GRANDE RD NE
ALBUQUERQUE NM
87111-3752
US

IV. Provider business mailing address

10405 OSO GRANDE RD NE
ALBUQUERQUE NM
87111-3752
US

V. Phone/Fax

Practice location:
  • Phone: 559-907-1433
  • Fax:
Mailing address:
  • Phone: 559-907-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE3441688
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: