Provider Demographics
NPI:1528416112
Name:DE LA ROSA, JUANA (RBT-15-05728)
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:RBT-15-05728
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 SW 10TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-3854
Mailing Address - Country:US
Mailing Address - Phone:786-800-8162
Mailing Address - Fax:
Practice Address - Street 1:641 SW 10TH ST APT 4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-3854
Practice Address - Country:US
Practice Address - Phone:786-800-8162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst