Provider Demographics
NPI:1013238971
Name:ROQUE, LEAH (CNA, HHA)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:ROQUE
Suffix:
Gender:F
Credentials:CNA, HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W SAN CARLOS ST
Mailing Address - Street 2:SUITE 1680
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-2726
Mailing Address - Country:US
Mailing Address - Phone:408-287-5007
Mailing Address - Fax:408-287-3505
Practice Address - Street 1:333 W SAN CARLOS ST
Practice Address - Street 2:SUITE 1680
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-2726
Practice Address - Country:US
Practice Address - Phone:408-287-5007
Practice Address - Fax:408-287-3505
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00239578374U00000X
CA00775413376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide