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NPI Code Detail

MEDICARE: ROSALI COSTAS

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
1106S00000XBehavior TechnicianRBT-18-66164FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID 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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