Provider Demographics
NPI:1154571594
Name:ROQUE, VERUCHKA
Entity type:Individual
Prefix:
First Name:VERUCHKA
Middle Name:
Last Name:ROQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VERUCHKAROQUE
Other - Middle Name:
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3626 SW EUROPE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5110
Mailing Address - Country:US
Mailing Address - Phone:718-869-3904
Mailing Address - Fax:
Practice Address - Street 1:3626 SW EUROPE ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5110
Practice Address - Country:US
Practice Address - Phone:718-869-3904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS TRANSITIONAL B174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist