Provider Demographics
NPI:1386253987
Name:COMPANIONI, ROSA ESTELA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:ESTELA
Last Name:COMPANIONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6704 COMMODORE WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-5810
Mailing Address - Country:US
Mailing Address - Phone:813-545-1188
Mailing Address - Fax:
Practice Address - Street 1:6704 COMMODORE WAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-5810
Practice Address - Country:US
Practice Address - Phone:813-545-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018822400Medicaid