Provider Demographics
NPI:1710201850
Name:JONES, ROQUEETA ROSE (DS II)
Entity Type:Individual
Prefix:
First Name:ROQUEETA
Middle Name:ROSE
Last Name:JONES
Suffix:
Gender:F
Credentials:DS II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 MENAUL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1614
Mailing Address - Country:US
Mailing Address - Phone:505-255-5501
Mailing Address - Fax:505-255-9971
Practice Address - Street 1:1111 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1614
Practice Address - Country:US
Practice Address - Phone:505-255-5501
Practice Address - Fax:505-255-9971
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251500000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health