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General NPI Number Information
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NPI Number | 1225623473
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Entity Type | Individual
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Provider Name | MANUELA ELISE ROBERTS
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Gender | Female
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Dates
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Enumeration Date | 03/09/2021
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 1661 W OAK RIDGE RD APT D
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City | ORLANDO
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State | FL
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Zip | 32809-3950
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Country | US
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Telephone | 407-536-1280
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Fax |
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Provider Business Mailing Address
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Address Line | 1661 W OAK RIDGE RD APT D
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City | ORLANDO
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State | FL
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Zip | 32809-3950
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Country | US
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Telephone | 407-536-1280
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number | R163-540-75-882-0
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License Number State | FL
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