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General NPI Number Information
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NPI Number | 1073968715
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Entity Type | Individual
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Provider Name | CRISTA MARINA ANA LUCIA ROSBOROUGH ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 05/02/2016
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 21403 SE 70TH AVE
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City | HAWTHORNE
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State | FL
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Zip | 32640
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Country | US
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Telephone | 412-477-9382
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Fax |
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Provider Business Mailing Address
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Address Line | 701 SW 62ND BLVD APT 90
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City | GAINESVILLE
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State | FL
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Zip | 32607-2078
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Country | US
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Telephone | 412-477-9382
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | AL4275
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License Number State | FL
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