Provider Demographics
NPI:1356382667
Name:ROQUE-GUERRERO, LILIA (MD)
Entity type:Individual
Prefix:MRS
First Name:LILIA
Middle Name:
Last Name:ROQUE-GUERRERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2401
Mailing Address - Country:US
Mailing Address - Phone:305-554-5588
Mailing Address - Fax:305-554-5560
Practice Address - Street 1:7455 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2401
Practice Address - Country:US
Practice Address - Phone:305-554-5588
Practice Address - Fax:305-554-5560
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56037208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063722000Medicaid
FL063722000Medicaid