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General NPI Number Information
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NPI Number | 1720978661
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Entity Type | Individual
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Provider Name | SOUNTHARY ROQUES RN
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Gender | Female
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 330 N D ST # 320
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City | SAN BERNARDINO
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State | CA
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Zip | 92401-1545
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Country | US
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Telephone | 909-893-2782
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Fax |
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Provider Business Mailing Address
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Address Line | 14783 GREEN LAWN DR
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City | MORENO VALLEY
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State | CA
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Zip | 92555-5744
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Country | US
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Telephone | 909-809-1160
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 95085621
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 95085621
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163WN0002X
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Taxonomy Name | Neonatal Intensive Care Registered Nurse
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License Number | 95085621
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 95085621
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License Number State | CA
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