Healthcare Provider Details

I. General information

NPI: 1447746441
Provider Name (Legal Business Name): WALFRIDO ROQUE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W 9TH ST
HIALEAH FL
33010-3853
US

IV. Provider business mailing address

267 E 51ST ST
HIALEAH FL
33013-1424
US

V. Phone/Fax

Practice location:
  • Phone: 786-703-1536
  • Fax:
Mailing address:
  • Phone: 786-973-1357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9318612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: