Provider Demographics
NPI:1851865158
Name:ROQUE, CHRISTINE MAGIDIE DUMAYAS (NP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MAGIDIE DUMAYAS
Last Name:ROQUE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1552 COFFEE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3122
Mailing Address - Country:US
Mailing Address - Phone:209-248-7168
Mailing Address - Fax:209-846-9641
Practice Address - Street 1:1552 COFFEE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3122
Practice Address - Country:US
Practice Address - Phone:209-248-7168
Practice Address - Fax:209-846-9641
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-20
Last Update Date:2022-08-05
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Provider Licenses
StateLicense IDTaxonomies
CANP95010802363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty