Healthcare Provider Details

I. General information

NPI: 1215514062
Provider Name (Legal Business Name): ROSALIA MILO GASCON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14520 SW 8TH ST
MIAMI FL
33184-3132
US

IV. Provider business mailing address

880 SW 129TH PL APT 103
MIAMI FL
33184-2108
US

V. Phone/Fax

Practice location:
  • Phone: 305-614-1230
  • Fax:
Mailing address:
  • Phone: 305-215-9585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-92866
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: