Healthcare Provider Details

I. General information

NPI: 1770132029
Provider Name (Legal Business Name): ZULEIDA ROQUE MESA RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15338 SW 36TH TER
MIAMI FL
33185-4700
US

IV. Provider business mailing address

15338 SW 36TH TER
MIAMI FL
33185-4700
US

V. Phone/Fax

Practice location:
  • Phone: 786-389-8963
  • Fax:
Mailing address:
  • Phone: 786-389-8963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-22-13983
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: