Provider Demographics
NPI:1649793126
Name:CONRIQUE, ROBERTO JOSEPH (AP, LAC)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:JOSEPH
Last Name:CONRIQUE
Suffix:
Gender:M
Credentials:AP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5456 GOLDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3294
Mailing Address - Country:US
Mailing Address - Phone:321-222-3773
Mailing Address - Fax:
Practice Address - Street 1:9318 E COLONIAL DR STE A15
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4175
Practice Address - Country:US
Practice Address - Phone:321-222-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3717171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist