Individual
ANNIE ROQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
747 52ND ST, OAKLAND, CA 94609-1809
(510) 428-4418
Mailing address
1428 BONITA AVE, BERKELEY, CA 94709-1909
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
95000457
CA
Other
Enumeration date
11/22/2023
Last updated
11/22/2023
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