MEDICARE: MS. IVETTY MILAGROS CABRERA ROSA SR.

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	103K00000X	Behavior Analyst	RBT-25-408279	FL

General Provider Information

NPI Number	:	1689488686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IVETTY MILAGROS CABRERA ROSA SR.

Provider Business Mailing Address
First Line	:	4666 PURDY LN
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-7452
Country	:	US
Telephone Number	:	561-993-0606
Fax Number	:

Provider Business Practice Location Address
First Line	:	4666 PURDY LN
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-7452
Country	:	US
Telephone Number	:	561-993-0606
Fax Number	:

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

Provider Enumeration Date	:	02/03/2025
Last Update Date	:	02/03/2025

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