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NPI Code Detail

MEDICARE: KHIARA ROSALES

MEDICARE: KHIARA ROSALES
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1912897414
Entity Type Code : Individual
Provider Name (Legal Business Name) : KHIARA ROSALES
Provider Business Mailing Address
First Line : 4935 HILLEGAS RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46818-1906
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2821 HILLEGAS RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46808-3859
Country : US
Telephone Number : 260-338-1241
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2025
Last Update Date : 05/19/2026

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Directions to “ KHIARA ROSALES ” Practice Location

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