Active NPI
Raymond Santos Roque, MD
- Family Medicine Physician
- Oakland, CA
National Provider Identifier
1134329774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD432058
- Practice address
- 6955 Foothill Blvd
Suite#188
Oakland, CA 94605-2455 - Phone
- (510) 746-5552
- NPI assigned
- Jul 23, 2007
- Last updated
- Jun 16, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD432058 | PA | Primary |
Addresses
Primary practice location
6955 Foothill Blvd
Suite#188
Oakland, CA 94605-2455
Mailing address
6955 Foothill Blvd
Suite#188
Oakland, CA 94605-2455
Phone (510) 746-5552
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD432058 | Other | PA | MEDICAL LICENSE |
| A108997 | Other | CA | MEDICAL BOARD OF CALIFORNIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD432058 | PA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466035200000",
"number": "1134329774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6955 FOOTHILL BLVD",
"address_2": "SUITE#188",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946052455",
"telephone_number": "510-746-5552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6955 FOOTHILL BLVD",
"address_2": "SUITE#188",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946052455",
"telephone_number": "510-746-5552"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROQUE",
"first_name": "RAYMOND",
"middle_name": "SANTOS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-23",
"last_updated": "2016-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "MD432058",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "MD432058",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL BOARD OF CALIFORNIA",
"identifier": "A108997",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.