Provider Demographics
NPI:1841150786
Name:COTALLO BARZAGA, ROSALIA D
Entity type:Individual
Prefix:
First Name:ROSALIA
Middle Name:D
Last Name:COTALLO BARZAGA
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 1:3075 SW 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5179
Mailing Address - Country:US
Mailing Address - Phone:786-874-9680
Mailing Address - Fax:
Practice Address - Street 1:3075 SW 61ST AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5179
Practice Address - Country:US
Practice Address - Phone:786-874-9680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-490275106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician