Healthcare Provider Details

I. General information

NPI: 1548114911
Provider Name (Legal Business Name): DABEL MENDEZ ROQUE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2729 NW 4TH TER
CAPE CORAL FL
33993-7022
US

IV. Provider business mailing address

2729 NW 4TH TER
CAPE CORAL FL
33993-7022
US

V. Phone/Fax

Practice location:
  • Phone: 786-569-5810
  • Fax:
Mailing address:
  • Phone: 786-569-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: