Provider Demographics
NPI:1871152355
Name:RODRIGUEZ, RAQUEL M
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:M
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:SUSUA BAJA SEC LA PALMITA
Mailing Address - Street 2:631 CALLE GRANADA
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:939-250-0205
Mailing Address - Fax:
Practice Address - Street 1:108 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-4060
Practice Address - Country:US
Practice Address - Phone:787-851-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR140271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14027OtherCLINICAL SOCIAL WORKER