Healthcare Provider Details

I. General information

NPI: 1972432482
Provider Name (Legal Business Name): MANUEL ARTURO BALDIZON ROJAS NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 W SAMPLE RD
DEERFIELD BEACH FL
33064-3542
US

IV. Provider business mailing address

6348 N MILWAUKEE AVE STE 390
CHICAGO IL
60646-3728
US

V. Phone/Fax

Practice location:
  • Phone: 847-235-6130
  • Fax: 847-235-6135
Mailing address:
  • Phone: 847-235-6130
  • Fax: 847-235-6135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11043993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: