Provider Demographics
NPI:1013600337
Name:RONDA, RAUL JR (LPN)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:RONDA
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201-1140
Mailing Address - Country:US
Mailing Address - Phone:201-993-1669
Mailing Address - Fax:
Practice Address - Street 1:106 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201-1140
Practice Address - Country:US
Practice Address - Phone:201-993-1669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP07894800164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse