Healthcare Provider Details

I. General information

NPI: 1477462869
Provider Name (Legal Business Name): MILAGRO ROSAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 SE 21ST ST
CAPE CORAL FL
33990-4657
US

IV. Provider business mailing address

PO BOX 150261
CAPE CORAL FL
33915-0261
US

V. Phone/Fax

Practice location:
  • Phone: 786-769-1246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-529619
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: