Healthcare Provider Details

I. General information

NPI: 1063026334
Provider Name (Legal Business Name): LIENA ROQUE MELGARES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 SOCIETY PL W APT G
WEST PALM BEACH FL
33415-3784
US

IV. Provider business mailing address

5130 SOCIETY PL W APT G
WEST PALM BEACH FL
33415-3784
US

V. Phone/Fax

Practice location:
  • Phone: 786-205-6954
  • Fax:
Mailing address:
  • Phone: 786-205-6954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-2579273
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: