Provider Demographics
NPI:1750699849
Name:ROQUE, ANIXA N/A (CABA)
Entity type:Individual
Prefix:MRS
First Name:ANIXA
Middle Name:N/A
Last Name:ROQUE
Suffix:
Gender:F
Credentials:CABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 SW 99TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1887
Mailing Address - Country:US
Mailing Address - Phone:305-485-8486
Mailing Address - Fax:305-485-8486
Practice Address - Street 1:622 SW 99TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1887
Practice Address - Country:US
Practice Address - Phone:305-485-8486
Practice Address - Fax:305-485-8486
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-04-1362103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst