Provider Demographics
NPI:1659966653
Name:ACANDA SEGURA, ROSA YOLEISY
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:YOLEISY
Last Name:ACANDA SEGURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E 2ND ST APT 6
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4956
Mailing Address - Country:US
Mailing Address - Phone:786-832-3754
Mailing Address - Fax:
Practice Address - Street 1:340 E 2ND ST APT 6
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4956
Practice Address - Country:US
Practice Address - Phone:786-832-3754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-127144106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician