MEDICARE: MISS ESMERALDA ROQUE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1013868199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ESMERALDA ROQUE

Provider Business Mailing Address
First Line	:	719 BRIDEWELL ST APT 132
Second Line	:	APT. 132
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-3065
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1524 MURCHISON ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1527
Country	:	US
Telephone Number	:	626-531-6999
Fax Number	:	626-531-6998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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Directions to “ MISS ESMERALDA ROQUE ” Practice Location

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