Provider Demographics
NPI:1609617844
Name:ROQUE RAMOS, ROGEL
Entity type:Individual
Prefix:
First Name:ROGEL
Middle Name:
Last Name:ROQUE RAMOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 NE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-8860
Mailing Address - Country:US
Mailing Address - Phone:239-699-6789
Mailing Address - Fax:
Practice Address - Street 1:2809 NE 4TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-8860
Practice Address - Country:US
Practice Address - Phone:239-699-6789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-351481106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician