Provider Demographics
NPI:1831881564
Name:ROA, EVER GABRIEL
Entity type:Individual
Prefix:
First Name:EVER
Middle Name:GABRIEL
Last Name:ROA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4492 ULMAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-6405
Mailing Address - Country:US
Mailing Address - Phone:941-536-7752
Mailing Address - Fax:
Practice Address - Street 1:2821 MICHAELANGELO DR STE 301
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1405
Practice Address - Country:US
Practice Address - Phone:956-362-2429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program