MEDICARE: IVETTE ROA-GARCIA

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	106S00000X	Behavior Technician	W1877353	CA

General Provider Information

NPI Number	:	1851251219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVETTE ROA-GARCIA

Provider Business Mailing Address
First Line	:	5029 E 10TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-5610
Country	:	US
Telephone Number	:	510-798-9924
Fax Number	:

Provider Business Practice Location Address
First Line	:	5029 E 10TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-5610
Country	:	US
Telephone Number	:	510-798-9924
Fax Number	:

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

Provider Enumeration Date	:	11/17/2025
Last Update Date	:	11/19/2025

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Directions to “ IVETTE ROA-GARCIA ” Practice Location

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