Provider Demographics
NPI:1861718124
Name:ROBERTY, RAYMOND
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:ROBERTY
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:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33008-0597
Mailing Address - Country:US
Mailing Address - Phone:786-554-1701
Mailing Address - Fax:
Practice Address - Street 1:401 LINTON BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-8193
Practice Address - Country:US
Practice Address - Phone:786-554-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8637247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other