Doctor Name: | LAUREN ROERO |
NPI Number: | 1003200585 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 9108595 |
Business Practice Address: | 1065 Ne 125th St #206 North Miami, FL - 331615821 |
Business Phone Number: | 3058910050 |
Business Fax Number: | |
Mailing Address: | 3100 Ne 164th St, NORTH MIAMI BEACH |
State: | FL |
Postal Code: | 331604130 |
Phone Number: | 3055059145 |
Fax Number: | |
NPI Enumeration Date: | 03/23/2015 |
NPI Last Update Date: | 03/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 9108595 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |