Provider Demographics
NPI:1962680769
Name:ROBERTO M ARIAS DC PA
Entity Type:Organization
Organization Name:ROBERTO M ARIAS DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATILDE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANCEL-ARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-847-8070
Mailing Address - Street 1:103 W OAK ST
Mailing Address - Street 2:STE C
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4401
Mailing Address - Country:US
Mailing Address - Phone:407-847-8070
Mailing Address - Fax:407-847-6330
Practice Address - Street 1:103 W OAK ST
Practice Address - Street 2:STE C
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4401
Practice Address - Country:US
Practice Address - Phone:407-847-8070
Practice Address - Fax:407-847-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2189Medicare PIN