Healthcare Provider Details

I. General information

NPI: 1295523991
Provider Name (Legal Business Name): YARAIMY ERILIAN ROQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 09/11/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 S UNIVERSITY DR STE 203
DAVIE FL
33328-5309
US

IV. Provider business mailing address

2900 NW 21ST CT APT 203
MIAMI FL
33142-6098
US

V. Phone/Fax

Practice location:
  • Phone: 305-889-8839
  • Fax:
Mailing address:
  • Phone: 305-889-8839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: