Provider Demographics
NPI:1912564006
Name:RODRIGUEZ, RAMON
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:RODRIGUEZ
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:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:HAGAMAN
Mailing Address - State:NY
Mailing Address - Zip Code:12086-0367
Mailing Address - Country:US
Mailing Address - Phone:518-842-5626
Mailing Address - Fax:518-620-2276
Practice Address - Street 1:58 N PAWLING ST
Practice Address - Street 2:
Practice Address - City:HAGAMAN
Practice Address - State:NY
Practice Address - Zip Code:12086
Practice Address - Country:US
Practice Address - Phone:518-842-5626
Practice Address - Fax:518-620-2276
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health