Provider Demographics
NPI:1861754608
Name:RODRIGUEZ, RAQUEL
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:RODRIGUEZ
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 1:2843 E 195TH ST
Mailing Address - Street 2:APT #1R
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3965
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2843 E 195TH ST
Practice Address - Street 2:APT #1R
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3965
Practice Address - Country:US
Practice Address - Phone:917-456-6496
Practice Address - Fax:718-430-6740
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator