Healthcare Provider Details

I. General information

NPI: 1124230032
Provider Name (Legal Business Name): ROSA LAMELAS RIQUENES CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12 AVE
MIAMI FL
33136
US

IV. Provider business mailing address

1821 SW 32ND CT
MIAMI FL
33145-2242
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1260
  • Fax:
Mailing address:
  • Phone: 305-444-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 4623
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: