Active NPI
Roman Christopher Roque, DO
- Psychiatry Physician
- Fresno, CA
National Provider Identifier
1992333413
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 19417
- Practice address
- 155 N Fresno St
Fresno, CA 93701-2302 - Phone
- (559) 499-6580
- NPI assigned
- Mar 30, 2020
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 1431 | CA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | 19417 | CA | Primary |
Addresses
Primary practice location
155 N Fresno St
Fresno, CA 93701-2302
Mailing address
155 N Fresno St
Fresno, CA 93701-2302
Other practice location 1
1060 W Sierra Ave Ste 105
Fresno, CA 93711-2063
Phone (559) 437-1111
Other practice location 2
4441 E Kings Canyon Rd
Fresno, CA 93702-3604
Phone (559) 600-6797
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1431 | Other | CA | POSTGRADUATE TRAINING LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666742400000",
"number": "1992333413",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "155 N FRESNO ST",
"city": "FRESNO",
"state": "CA",
"postal_code": "937012302"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 N FRESNO ST",
"city": "FRESNO",
"state": "CA",
"postal_code": "937012302",
"telephone_number": "559-499-6580"
}
],
"practiceLocations": [
{
"address_1": "1060 W Sierra Ave Ste 105",
"address_purpose": "LOCATION",
"city": "Fresno",
"state": "CA",
"postal_code": "937112063",
"country_code": "US",
"telephone_number": "559-437-1111",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4441 E Kings Canyon Rd",
"address_purpose": "LOCATION",
"city": "Fresno",
"state": "CA",
"postal_code": "937023604",
"country_code": "US",
"telephone_number": "559-600-6797",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROQUE",
"first_name": "ROMAN CHRISTOPHER",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-30",
"last_updated": "2022-10-26",
"certification_date": "2022-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "1431",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "19417",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "POSTGRADUATE TRAINING LICENSE",
"identifier": "1431",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.