MEDICARE: DIAMANTE ROSA ALFONSO BCBA

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	RBT20121212	FL
2	103K00000X	Behavior Analyst	BCBA-1-25-84979	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	:	1730704180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIAMANTE ROSA ALFONSO BCBA

Provider Business Mailing Address
First Line	:	8359 BEACON BLVD STE 416
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3065
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 NW 5TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-2300
Country	:	US
Telephone Number	:	239-600-8171
Fax Number	:

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

Provider Enumeration Date	:	06/11/2020
Last Update Date	:	03/02/2026

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