Provider Demographics
NPI:1639251168
Name:HEALTH CARE AGENCY (CEGU)
Entity Type:Organization
Organization Name:HEALTH CARE AGENCY (CEGU)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST I
Authorized Official - Prefix:DR
Authorized Official - First Name:ARACELY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:714-935-8248
Mailing Address - Street 1:11652 CANDY LN
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-2554
Mailing Address - Country:US
Mailing Address - Phone:714-590-9969
Mailing Address - Fax:
Practice Address - Street 1:305 THE CITY DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-935-8248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 41740251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health