Healthcare Provider Details

I. General information

NPI: 1639979339
Provider Name (Legal Business Name): JENNIFER ROQUE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21063 SW 119TH CT
MIAMI FL
33177-5365
US

IV. Provider business mailing address

21063 SW 119TH CT
MIAMI FL
33177-5365
US

V. Phone/Fax

Practice location:
  • Phone: 786-241-7871
  • Fax:
Mailing address:
  • Phone: 786-241-7871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: