Healthcare Provider Details

I. General information

NPI: 1760645725
Provider Name (Legal Business Name): RHIANA ROQUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 E COLORADO BLVD STE 500
PASADENA CA
91106-2371
US

IV. Provider business mailing address

556 S FAIR OAKS AVE STE 101-458
PASADENA CA
91105-2656
US

V. Phone/Fax

Practice location:
  • Phone: 626-314-1901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA112171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: