Provider Demographics
NPI:1477754083
Name:ROQUE, DONNA MARIA (MA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIA
Last Name:ROQUE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E FOOTHILL BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-7102
Mailing Address - Country:US
Mailing Address - Phone:626-993-3000
Mailing Address - Fax:626-993-3081
Practice Address - Street 1:2500 E FOOTHILL BLVD STE 300
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-7102
Practice Address - Country:US
Practice Address - Phone:626-993-3000
Practice Address - Fax:626-993-3081
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator