Healthcare Provider Details

I. General information

NPI: 1013238971
Provider Name (Legal Business Name): LEAH ROQUE C.N.A, H.H.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W SAN CARLOS ST SUITE 1680
SAN JOSE CA
95110-2726
US

IV. Provider business mailing address

333 W SAN CARLOS ST SUITE 1680
SAN JOSE CA
95110-2726
US

V. Phone/Fax

Practice location:
  • Phone: 408-287-5007
  • Fax: 408-287-3505
Mailing address:
  • Phone: 408-287-5007
  • Fax: 408-287-3505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number00239578
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00775413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: