MEDICARE: ROSA ALONSO MA, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-19-37761	FL

General Provider Information

NPI Number	:	1811288640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA ALONSO MA, BCBA

Provider Business Mailing Address
First Line	:	792 W LUMSDEN RD
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-6260
Country	:	US
Telephone Number	:	813-324-7538
Fax Number	:	813-324-7538

Provider Business Practice Location Address
First Line	:	792 W LUMSDEN RD
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-6260
Country	:	US
Telephone Number	:	813-324-7538
Fax Number	:	813-324-7538

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2011
Last Update Date	:	09/30/2025

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