Healthcare Provider Details

I. General information

NPI: 1982522249
Provider Name (Legal Business Name): ROBERTO MANZANILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 NE 4TH ST APT 101
DELRAY BEACH FL
33483-5539
US

IV. Provider business mailing address

613 NE 4TH ST APT 101
DELRAY BEACH FL
33483-5539
US

V. Phone/Fax

Practice location:
  • Phone: 305-588-0148
  • Fax:
Mailing address:
  • Phone: 305-588-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: