Provider Demographics
NPI:1700873619
Name:RAQ CORPORATION
Entity type:Organization
Organization Name:RAQ CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASCENSION
Authorized Official - Middle Name:CONTRERAS
Authorized Official - Last Name:MENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-562-1506
Mailing Address - Street 1:907 CHELSEA ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-4912
Mailing Address - Country:US
Mailing Address - Phone:915-562-1506
Mailing Address - Fax:915-562-1866
Practice Address - Street 1:907 CHELSEA ST
Practice Address - Street 2:STE G
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-4912
Practice Address - Country:US
Practice Address - Phone:915-562-1506
Practice Address - Fax:915-562-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0031300332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0119935-01Medicaid
TX0119935-01Medicaid