Provider Demographics
NPI:1720978661
Name:ROQUES, SOUNTHARY (RN)
Entity type:Individual
Prefix:
First Name:SOUNTHARY
Middle Name:
Last Name:ROQUES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14783 GREEN LAWN DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-5744
Mailing Address - Country:US
Mailing Address - Phone:909-809-1160
Mailing Address - Fax:
Practice Address - Street 1:330 N D ST # 320
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1545
Practice Address - Country:US
Practice Address - Phone:909-893-2782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95085621163WN0002X, 163WP0200X, 163WC0400X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health