Provider Demographics
NPI:1316609571
Name:ROSERO ARANGO, MANUELA (PA-C)
Entity type:Individual
Prefix:
First Name:MANUELA
Middle Name:
Last Name:ROSERO ARANGO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S MIAMI AVE UNIT 4810
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-4543
Mailing Address - Country:US
Mailing Address - Phone:206-790-5737
Mailing Address - Fax:
Practice Address - Street 1:3868 SHERIDAN ST STE A
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3623
Practice Address - Country:US
Practice Address - Phone:954-962-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115081363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant