MEDICARE: JAQUELINE 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	101Y00000X	Counselor	94072	TX

General Provider Information

NPI Number	:	1679445480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAQUELINE ROQUE

Provider Business Mailing Address
First Line	:	903 KEYSTONE DR
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78572-6073
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 W TRENTON RD UNIT A
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-4674
Country	:	US
Telephone Number	:	956-672-7500
Fax Number	:

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

Provider Enumeration Date	:	09/22/2025
Last Update Date	:	09/22/2025

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Directions to “ JAQUELINE ROQUE ” Practice Location

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