Provider Demographics
NPI:1568503100
Name:ROQUE, GABRIELA (RN)
Entity Type:Individual
Prefix:MS
First Name:GABRIELA
Middle Name:
Last Name:ROQUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 OLD SONOMA RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-3708
Mailing Address - Country:US
Mailing Address - Phone:707-253-4139
Mailing Address - Fax:707-253-4880
Practice Address - Street 1:2344 OLD SONOMA RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3708
Practice Address - Country:US
Practice Address - Phone:707-253-4139
Practice Address - Fax:707-253-4880
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA523102163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management