Healthcare Provider Details

I. General information

NPI: 1366165581
Provider Name (Legal Business Name): ALEJANDRA ROQUE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11840 S LA CIENEGA BLVD
HAWTHORNE CA
90250-3459
US

IV. Provider business mailing address

8371 LA VILLA ST
DOWNEY CA
90241-3826
US

V. Phone/Fax

Practice location:
  • Phone: 424-269-3400
  • Fax: 310-882-5451
Mailing address:
  • Phone: 562-522-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number302757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: