Provider Demographics
NPI:1497561823
Name:ROJO, KAE MICHELLE
Entity type:Individual
Prefix:
First Name:KAE
Middle Name:MICHELLE
Last Name:ROJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAELUN
Other - Middle Name:MICHELLE
Other - Last Name:BOLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:428 10TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-4036
Mailing Address - Country:US
Mailing Address - Phone:505-859-8388
Mailing Address - Fax:
Practice Address - Street 1:428 10TH AVE NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-4036
Practice Address - Country:US
Practice Address - Phone:505-859-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician