Individual
LAZARO ROQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1897 NE 146TH ST, NORTH MIAMI, FL 33181-1423
(305) 949-4191
(305) 949-4833
Mailing address
1897 NE 146TH ST, NORTH MIAMI, FL 33181-1423
(305) 949-4191
(305) 949-4833
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OAT 11601
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OAT11601
COTA FLORIDA LICENSE
FL
Enumeration date
02/07/2011
Last updated
02/07/2011
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