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General NPI Number Information
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NPI Number | 1013491018
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Entity Type | Individual
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Provider Name | ALLISON ROQUE
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Gender | Female
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Dates
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Enumeration Date | 09/17/2018
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 1224 HAMMOND DR NE STE 1500
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City | ATLANTA
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State | GA
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Zip | 30346-1537
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Country | US
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Telephone | 855-485-8732
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Fax |
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Provider Business Mailing Address
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Address Line | 212 MIRALUNA DR
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City | SAN BRUNO
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State | CA
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Zip | 94066-1765
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Country | US
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Telephone | 916-749-5031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 728611
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License Number State | CA
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