Provider Demographics
NPI:1477872026
Name:CEDENO ROSS, RAQUEL B
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:B
Last Name:CEDENO ROSS
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 1:10 MITCHELL ST
Mailing Address - Street 2:APT4
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5131
Mailing Address - Country:US
Mailing Address - Phone:347-987-9630
Mailing Address - Fax:
Practice Address - Street 1:10 MITCHELL ST
Practice Address - Street 2:APT4
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5131
Practice Address - Country:US
Practice Address - Phone:347-987-9630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY627057-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse