Provider Demographics
NPI:1336605112
Name:LA ROSA, DORIS (BCABA)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:LA ROSA
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14106 SW 160TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6503
Mailing Address - Country:US
Mailing Address - Phone:305-613-1183
Mailing Address - Fax:
Practice Address - Street 1:14106 SW 160TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-6503
Practice Address - Country:US
Practice Address - Phone:305-613-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-16
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst