MEDICARE: ROSALI COSTAS

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	RBT-18-66164	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588210413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALI COSTAS

Provider Business Mailing Address
First Line	:	3163 W 78TH PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-3848
Country	:	US
Telephone Number	:	786-458-3113
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 COLONIAL BLVD STE 102
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1025
Country	:	US
Telephone Number	:	239-294-0901
Fax Number	:

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

Provider Enumeration Date	:	08/15/2019
Last Update Date	:	11/17/2022

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Directions to “ ROSALI COSTAS ” Practice Location

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