MEDICARE: ROSA N DIPAOLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1063910313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA N DIPAOLA

Provider Business Mailing Address
First Line	:	21505 N 78TH AVE STE 125
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-3356
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21505 N 78TH AVE STE 125
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-3356
Country	:	US
Telephone Number	:	480-369-4550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2018
Last Update Date	:	01/31/2018

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Directions to “ ROSA N DIPAOLA ” Practice Location

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