Provider Demographics
NPI:1750882627
Name:ROSAS, LUIS A
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:A
Last Name:ROSAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 NW 12TH AVE APT 901
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33128-2203
Mailing Address - Country:US
Mailing Address - Phone:305-562-8487
Mailing Address - Fax:
Practice Address - Street 1:10101 SW 154TH CIRCLE CT APT 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-3890
Practice Address - Country:US
Practice Address - Phone:305-562-8487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst