Provider Demographics
NPI:1134333032
Name:VALLABRIGAS, ROQUE ENRIQUE (PA-C)
Entity type:Individual
Prefix:
First Name:ROQUE
Middle Name:ENRIQUE
Last Name:VALLABRIGAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 924165
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33092-4165
Mailing Address - Country:US
Mailing Address - Phone:305-573-9898
Mailing Address - Fax:305-573-3711
Practice Address - Street 1:258 NE 27TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4522
Practice Address - Country:US
Practice Address - Phone:305-573-9898
Practice Address - Fax:305-573-3711
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100862363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291641000Medicaid
FL291641000Medicaid
FLU4080Medicare PIN