Provider Demographics
NPI:1255170726
Name:CAMACHO ALAZO, ROSA MERCEDES
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:MERCEDES
Last Name:CAMACHO ALAZO
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 1:8001 SW 36TH STREET SUITE #9
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328
Mailing Address - Country:US
Mailing Address - Phone:954-577-7790
Mailing Address - Fax:954-577-7780
Practice Address - Street 1:8001 SW 36TH STREET SUITE #9
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328
Practice Address - Country:US
Practice Address - Phone:954-577-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician