Provider Demographics
NPI:1619509593
Name:RAQUEL, MA. CASANDRA PADIOS
Entity Type:Individual
Prefix:MS
First Name:MA. CASANDRA
Middle Name:PADIOS
Last Name:RAQUEL
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 1:108 ROLLING MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:SAYLORSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18353-9387
Mailing Address - Country:US
Mailing Address - Phone:954-258-8734
Mailing Address - Fax:
Practice Address - Street 1:829 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:EYNON
Practice Address - State:PA
Practice Address - Zip Code:18403-1020
Practice Address - Country:US
Practice Address - Phone:570-383-7502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027696208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation