Provider Demographics
NPI:1699520239
Name:ROSA, CESAR AUGUSTO (RMFTI)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:AUGUSTO
Last Name:ROSA
Suffix:
Gender:M
Credentials:RMFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 NW 107TH AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1885
Mailing Address - Country:US
Mailing Address - Phone:202-938-7330
Mailing Address - Fax:
Practice Address - Street 1:4500 NW 107TH AVE APT 201
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-1885
Practice Address - Country:US
Practice Address - Phone:202-938-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT4055.106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist