Provider Demographics
NPI:1437648649
Name:ROSA, ELENA (LM CPM)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:LM CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 LOOKOUT PL
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-8433
Mailing Address - Country:US
Mailing Address - Phone:407-920-0405
Mailing Address - Fax:844-852-6870
Practice Address - Street 1:237 LOOKOUT PL
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-8433
Practice Address - Country:US
Practice Address - Phone:407-920-0405
Practice Address - Fax:844-852-6870
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW363176B00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty