Healthcare Provider Details

I. General information

NPI: 1255183943
Provider Name (Legal Business Name): ROQUE GONZALEZ SALDIVAR JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 XIMENO AVE
LONG BEACH CA
90815-2850
US

IV. Provider business mailing address

750 N COMMONS DR STE 200
AURORA IL
60504-8025
US

V. Phone/Fax

Practice location:
  • Phone: 562-494-7374
  • Fax: 562-597-8736
Mailing address:
  • Phone: 630-303-5380
  • Fax: 630-303-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number5846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: