Provider Demographics
NPI:1588470900
Name:LA ROSA PERILLA, ADRIANA
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:LA ROSA PERILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:GABRIELA
Other - Last Name:LA ROSA MACHADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4387 CREEK COVE LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-9490
Mailing Address - Country:US
Mailing Address - Phone:832-498-9810
Mailing Address - Fax:
Practice Address - Street 1:4387 CREEK COVE LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-9490
Practice Address - Country:US
Practice Address - Phone:832-498-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-398328106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician