Individual
CHANEL AMBER ROSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15325 TREVISO ST, ORLANDO, FL 32828-6777
(407) 259-5553
Mailing address
15325 TREVISO ST, ORLANDO, FL 32828-6777
(407) 259-5553
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
R200-101-93-834-1
FL
Other
Enumeration date
08/11/2016
Last updated
08/11/2016
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