Provider Demographics
NPI:1891545778
Name:ROSALES, DANIELA MICHELLE
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:MICHELLE
Last Name:ROSALES
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 1:571 NW 184TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4419
Mailing Address - Country:US
Mailing Address - Phone:786-370-5521
Mailing Address - Fax:
Practice Address - Street 1:2598 E SUNRISE BLVD # 2104
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3230
Practice Address - Country:US
Practice Address - Phone:954-235-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician