Provider Demographics
NPI:1275676322
Name:RAY PROFESSIONAL GROUP, INC.
Entity Type:Organization
Organization Name:RAY PROFESSIONAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMUNDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-463-9736
Mailing Address - Street 1:8045 NW 36TH ST
Mailing Address - Street 2:534
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6627
Mailing Address - Country:US
Mailing Address - Phone:305-463-9736
Mailing Address - Fax:305-463-9737
Practice Address - Street 1:8045 NW 36TH ST
Practice Address - Street 2:534
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6627
Practice Address - Country:US
Practice Address - Phone:305-463-9736
Practice Address - Fax:305-463-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5969770001Medicare NSC