Provider Demographics
NPI:1922711738
Name:ROQUE, OSCAR ENRIQUE
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:ENRIQUE
Last Name:ROQUE
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 1:712 1/2 E PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3421
Mailing Address - Country:US
Mailing Address - Phone:626-802-0507
Mailing Address - Fax:
Practice Address - Street 1:1395 E ORANGE GROVE BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-3039
Practice Address - Country:US
Practice Address - Phone:626-802-0507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator