Provider Demographics
NPI:1760870315
Name:ROQUE, ANABEL LUCIA
Entity Type:Individual
Prefix:
First Name:ANABEL
Middle Name:LUCIA
Last Name:ROQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9061 SW 156TH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1971
Mailing Address - Country:US
Mailing Address - Phone:786-488-5091
Mailing Address - Fax:
Practice Address - Street 1:9061 SW 156TH ST APT 208
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1971
Practice Address - Country:US
Practice Address - Phone:786-488-5091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3583171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist