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General NPI Number Information
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NPI Number | 1073182580
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Entity Type | Individual
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Provider Name | KEYLA M ROSARIO
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Gender | Female
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Dates
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Enumeration Date | 06/19/2021
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Last Update Date | 06/19/2021
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Provider Practice Location Address
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Address Line | 14728 ROYAL POINCIANA DR
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City | ORLANDO
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State | FL
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Zip | 32828-7329
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Country | US
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Telephone | 407-416-0810
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Fax |
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Provider Business Mailing Address
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Address Line | 11508 BALTIC ST
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City | ORLANDO
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State | FL
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Zip | 32817-4437
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Country | US
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Telephone | 407-535-6940
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BACB554207
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License Number State | FL
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