Healthcare Provider Details

I. General information

NPI: 1841004660
Provider Name (Legal Business Name): FLAVIA K ROQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18234 SW 144TH PL
MIAMI FL
33177-3325
US

IV. Provider business mailing address

18234 SW 144TH PL
MIAMI FL
33177-3325
US

V. Phone/Fax

Practice location:
  • Phone: 786-587-6225
  • Fax:
Mailing address:
  • Phone: 786-587-6225
  • 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: