Healthcare Provider Details

I. General information

NPI: 1225296254
Provider Name (Legal Business Name): ARACELY ROQUE PSY. D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 THE CITY DR S
ORANGE CA
92868-3205
US

IV. Provider business mailing address

301 THE CITY DR S
ORANGE CA
92868-3205
US

V. Phone/Fax

Practice location:
  • Phone: 714-935-6766
  • Fax:
Mailing address:
  • Phone: 714-935-6766
  • Fax: 714-903-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: