Provider Demographics
NPI:1225750466
Name:ROQUE, OSUNI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:OSUNI
Middle Name:
Last Name:ROQUE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 SW 69TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2006
Mailing Address - Country:US
Mailing Address - Phone:786-853-3889
Mailing Address - Fax:
Practice Address - Street 1:10205 S DIXIE HWY STE 203
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-3168
Practice Address - Country:US
Practice Address - Phone:305-662-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11631103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical