Provider Demographics
NPI:1285077479
Name:PLAZA, ROSA EVELYN
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:EVELYN
Last Name:PLAZA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9958 JONAS SALK DR APT 308
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-7456
Mailing Address - Country:US
Mailing Address - Phone:813-841-3182
Mailing Address - Fax:
Practice Address - Street 1:9958 JONAS SALK DR APT 308
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7456
Practice Address - Country:US
Practice Address - Phone:813-841-3182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW19200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health