MEDICARE: MISS MICHELLE ALEXANDRA LA ROTTA RD

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	133V00000X	Registered Dietitian	9988	FL

General Provider Information

NPI Number	:	1265031967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHELLE ALEXANDRA LA ROTTA RD

Provider Business Mailing Address
First Line	:	16080 S POST RD APT 203
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33331-3541
Country	:	US
Telephone Number	:	954-736-8522
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 NW 22ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-7742
Country	:	US
Telephone Number	:	954-736-8522
Fax Number	:

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

Provider Enumeration Date	:	10/22/2020
Last Update Date	:	10/22/2020

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