MEDICARE: TATIANA PATRICIA MANRIQUE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	SI1147	FL

General Provider Information

NPI Number	:	1245381284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANA PATRICIA MANRIQUE

Provider Business Mailing Address
First Line	:	7220 NW 114TH AVE APT 211
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-5564
Country	:	US
Telephone Number	:	305-513-4048
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 TOWN CENTER CIR STE A
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-3637
Country	:	US
Telephone Number	:	954-385-3456
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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