Provider Demographics
NPI:1922883354
Name:GONZALEZ-ROQUE, GINA FRANCISCA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:FRANCISCA
Last Name:GONZALEZ-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 1:1655 W 56TH ST APT 320
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2094
Mailing Address - Country:US
Mailing Address - Phone:786-389-9984
Mailing Address - Fax:
Practice Address - Street 1:1655 W 56TH ST APT 320
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2094
Practice Address - Country:US
Practice Address - Phone:786-389-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB928934106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician