Healthcare Provider Details

I. General information

NPI: 1841921400
Provider Name (Legal Business Name): GUADALUPE ESMERALDA ROQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 E PRICE RD
BROWNSVILLE TX
78521-3527
US

IV. Provider business mailing address

191 E PRICE RD
BROWNSVILLE TX
78521-3527
US

V. Phone/Fax

Practice location:
  • Phone: 956-548-7400
  • Fax: 956-621-3689
Mailing address:
  • Phone: 956-548-7400
  • Fax: 956-621-3689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17953
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: