Provider Demographics
NPI:1811654353
Name:ROQUE, AMELIA NICOLE
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:NICOLE
Last Name: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 1:1125 JACKSON CT
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-5033
Mailing Address - Country:US
Mailing Address - Phone:831-917-8700
Mailing Address - Fax:
Practice Address - Street 1:8767 CARMEL VALLEY RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-7958
Practice Address - Country:US
Practice Address - Phone:831-582-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program