Individual
DIANE T ROQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
710 S CENTRAL AVE STE 330, GLENDALE, CA 91204-4647
(818) 263-5737
(818) 263-5737
Mailing address
119 N ARDMORE AVE, LOS ANGELES, CA 90004-4501
(818) 263-5737
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95008440
CA
Other
Enumeration date
03/13/2018
Last updated
03/13/2018
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