Provider Demographics
NPI:1629956339
Name:ROQUE REINOSA, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:ROQUE REINOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 W BROADWAY APT 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1938
Mailing Address - Country:US
Mailing Address - Phone:925-519-3919
Mailing Address - Fax:
Practice Address - Street 1:341 W BROADWAY APT 1
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-1938
Practice Address - Country:US
Practice Address - Phone:925-519-3919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2367767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse