Provider Demographics
NPI:1679340616
Name:DEL ROSARIO, ANGEL MIGUEL
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:MIGUEL
Last Name:DEL ROSARIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:MIGUEL
Other - Last Name:DEL ROSARIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9719 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2834
Mailing Address - Country:US
Mailing Address - Phone:786-564-9660
Mailing Address - Fax:
Practice Address - Street 1:9719 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-2834
Practice Address - Country:US
Practice Address - Phone:786-564-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-300508106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician