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NPI Code Detail

MEDICARE: JOCELYN WILGEM ROQUE

MEDICARE: JOCELYN WILGEM 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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1285114942
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOCELYN WILGEM ROQUE
Provider Business Mailing Address
First Line : 2632 BATON ROUGE DR
Second Line :
City : SAN JOSE
State : CA
Zip : 95133-2636
Country : US
Telephone Number : 408-821-5300
Fax Number :
Provider Business Practice Location Address
First Line : 2632 BATON ROUGE DR
Second Line :
City : SAN JOSE
State : CA
Zip : 95133-2636
Country : US
Telephone Number : 408-821-5300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2018
Last Update Date : 08/21/2018

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Directions to “ JOCELYN WILGEM ROQUE ” Practice Location

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