Provider Demographics
NPI:1265031967
Name:LA ROTTA, MICHELLE ALEXANDRA (RD)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:ALEXANDRA
Last Name:LA ROTTA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16080 S POST RD APT 203
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3541
Mailing Address - Country:US
Mailing Address - Phone:954-736-8522
Mailing Address - Fax:
Practice Address - Street 1:1404 NW 22ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-7742
Practice Address - Country:US
Practice Address - Phone:954-736-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9988133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered