Healthcare Provider Details

I. General information

NPI: 1801730601
Provider Name (Legal Business Name): MANUELA GOYENECHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BILLINGSLEY RD
CHARLOTTE NC
28211-1009
US

IV. Provider business mailing address

CALLE 119 #11B-83 APARTMENT 302
BOGOTA BOGOTA
11010
CO

V. Phone/Fax

Practice location:
  • Phone: 704-444-2400
  • Fax: 704-358-2516
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: