MEDICARE: JENNIFER C RAROQUE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	11178	NV

General Provider Information

NPI Number	:	1316995434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER C RAROQUE M.D.

Provider Business Mailing Address
First Line	:	10624 S EASTERN AVE STE A-955
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2982
Country	:	US
Telephone Number	:	702-380-1888
Fax Number	:	702-463-1507

Provider Business Practice Location Address
First Line	:	10624 S EASTERN AVE STE A-955
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2982
Country	:	US
Telephone Number	:	702-380-1888
Fax Number	:	702-463-1507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/07/2014

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