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General NPI Number Information
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NPI Number | 1669043972
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Entity Type | Individual
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Provider Name | EDUARDO ARMANDO ROQUESO
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Gender | Male
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Dates
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Enumeration Date | 07/07/2021
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Last Update Date | 03/16/2024
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Provider Practice Location Address
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Address Line | 17061 NW 82ND AVE
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City | HIALEAH
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State | FL
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Zip | 33015-3701
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Country | US
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Telephone | 786-525-4933
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Fax |
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Provider Business Mailing Address
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Address Line | 17061 NW 82ND AVE
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City | HIALEAH
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State | FL
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Zip | 33015-3701
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Country | US
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Telephone | 786-525-4933
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN11005275
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License Number State | FL
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