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General NPI Number Information
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NPI Number | 1922711738
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Entity Type | Individual
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Provider Name | OSCAR ENRIQUE ROQUE
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Gender | Male
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Dates
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Enumeration Date | 12/27/2022
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 1395 E ORANGE GROVE BLVD
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City | PASADENA
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State | CA
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Zip | 91104-3039
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Country | US
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Telephone | 626-802-0507
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Fax |
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Provider Business Mailing Address
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Address Line | 712 1/2 E PALMER AVE
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City | GLENDALE
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State | CA
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Zip | 91205-3421
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Country | US
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Telephone | 626-802-0507
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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 | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State | CA
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