Provider Demographics
NPI:1700439155
Name:ZAQUEN, RAYMONDO
Entity Type:Individual
Prefix:
First Name:RAYMONDO
Middle Name:
Last Name:ZAQUEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 S STUART ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-4922
Mailing Address - Country:US
Mailing Address - Phone:410-682-5742
Mailing Address - Fax:
Practice Address - Street 1:295 S STUART ST
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-4922
Practice Address - Country:US
Practice Address - Phone:410-682-5742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD38-4030490374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide