Provider Demographics
NPI:1679009195
Name:RIGUAL ROQUE, JUAN
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:RIGUAL ROQUE
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 1:1428 SW 4TH ST
Mailing Address - Street 2:APT 5
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2244
Mailing Address - Country:US
Mailing Address - Phone:786-800-7242
Mailing Address - Fax:
Practice Address - Street 1:1428 SW 4TH ST
Practice Address - Street 2:APT 5
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2244
Practice Address - Country:US
Practice Address - Phone:786-800-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician