Provider Demographics
NPI:1053820258
Name:TAQUE, JOSE CARLOS
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:CARLOS
Last Name:TAQUE
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 1:1550 S DIXIE HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3034
Mailing Address - Country:US
Mailing Address - Phone:786-536-9714
Mailing Address - Fax:
Practice Address - Street 1:2141 SW 1ST ST STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1695
Practice Address - Country:US
Practice Address - Phone:305-644-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health