Provider Demographics
NPI:1164168589
Name:PAULINO, RADISEL
Entity Type:Individual
Prefix:
First Name:RADISEL
Middle Name:
Last Name:PAULINO
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 1:225 NAPLES TER APT 1B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5411
Mailing Address - Country:US
Mailing Address - Phone:347-863-4404
Mailing Address - Fax:
Practice Address - Street 1:225 NAPLES TER APT 1B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5411
Practice Address - Country:US
Practice Address - Phone:347-863-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator