MEDICARE: ISABEL LIDICE ROJAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	09219654	OH

General Provider Information

NPI Number	:	1104771393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABEL LIDICE ROJAS

Provider Business Mailing Address
First Line	:	3656 W 133RD ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3402
Country	:	US
Telephone Number	:	216-965-5966
Fax Number	:	216-965-5966

Provider Business Practice Location Address
First Line	:	3656 W 133RD ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3402
Country	:	US
Telephone Number	:	216-965-5966
Fax Number	:	216-965-5966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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