Provider Demographics
NPI:1891364584
Name:LOPEZ-RODRIGUEZ, ALTAGRACIA RAQUELINA
Entity Type:Individual
Prefix:
First Name:ALTAGRACIA
Middle Name:RAQUELINA
Last Name:LOPEZ-RODRIGUEZ
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 1:15017 114TH RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-1001
Mailing Address - Country:US
Mailing Address - Phone:347-485-7560
Mailing Address - Fax:
Practice Address - Street 1:15017 114TH RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1001
Practice Address - Country:US
Practice Address - Phone:347-485-7560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator