Provider Demographics
NPI:1083328603
Name:RODRIGUEZ, RAULDELIS O
Entity Type:Individual
Prefix:
First Name:RAULDELIS
Middle Name:O
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2549 REDBUD LN APT 4
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-5706
Mailing Address - Country:US
Mailing Address - Phone:786-572-5811
Mailing Address - Fax:
Practice Address - Street 1:2549 REDBUD LN APT 4
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-5706
Practice Address - Country:US
Practice Address - Phone:786-572-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician