Provider Demographics
NPI:1912443946
Name:RODRIGUEZ, RAQUEL ALEJANDRA
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:ALEJANDRA
Last Name: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 1:905 MCCLELLAND AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-6280
Mailing Address - Country:US
Mailing Address - Phone:956-612-7778
Mailing Address - Fax:
Practice Address - Street 1:905 MCCLELLAND AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-6280
Practice Address - Country:US
Practice Address - Phone:956-612-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-14
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health