Healthcare Provider Details

I. General information

NPI: 1053216101
Provider Name (Legal Business Name): YADIRA ROSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18901 SW 106TH AVE STE 224
CUTLER BAY FL
33157-7665
US

IV. Provider business mailing address

395 SW 17TH AVE
HOMESTEAD FL
33030-6638
US

V. Phone/Fax

Practice location:
  • Phone: 786-413-7498
  • Fax:
Mailing address:
  • Phone: 786-413-7498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number35525
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: