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NPI Code Detail

MEDICARE: MR. JASON M ROSA

MEDICARE: MR. JASON M ROSA
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 Technician

General Provider Information

NPI Number : 1851730964
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JASON M ROSA
Provider Business Mailing Address
First Line : 5446 N ACADEMY BLVD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-3644
Country : US
Telephone Number : 719-201-1053
Fax Number :
Provider Business Practice Location Address
First Line : 5446 N ACADEMY BLVD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-3644
Country : US
Telephone Number : 719-246-8440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2013
Last Update Date : 12/21/2017

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