Provider Demographics
NPI:1760718233
Name:MANUEL, ROXANA (PA-C)
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:MANUEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ROXANA
Other - Middle Name:
Other - Last Name:CUEVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:840 E MCKELLIPS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-9654
Mailing Address - Country:US
Mailing Address - Phone:602-491-0703
Mailing Address - Fax:480-631-0581
Practice Address - Street 1:1010 W LA VETA AVE STE 615
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4310
Practice Address - Country:US
Practice Address - Phone:714-223-7000
Practice Address - Fax:833-471-2055
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20577363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical