MEDICARE: MAITE DE LA ROSA SLP

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	235Z00000X	Speech-Language Pathologist	SA16748	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	:	1700287026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAITE DE LA ROSA SLP

Provider Business Mailing Address
First Line	:	6840 SW 40TH ST STE 211A
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-3756
Country	:	US
Telephone Number	:	305-461-4702
Fax Number	:

Provider Business Practice Location Address
First Line	:	6840 SW 40TH ST STE 211A
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-3756
Country	:	US
Telephone Number	:	305-461-4702
Fax Number	:

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

Provider Enumeration Date	:	09/05/2014
Last Update Date	:	05/28/2019

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Directions to “ MAITE DE LA ROSA SLP” Practice Location

Language	Start Address	Practice Location

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