Healthcare Provider Details

I. General information

NPI: 1922486638
Provider Name (Legal Business Name): NORMA B ROQUE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 04/27/2023
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10980 SW 184TH ST
CUTLER BAY FL
33157-6615
US

IV. Provider business mailing address

8750 NW 36TH ST STE 300
DORAL FL
33178-2499
US

V. Phone/Fax

Practice location:
  • Phone: 305-266-2929
  • Fax: 305-627-3862
Mailing address:
  • Phone: 305-262-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9108145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: