Provider Demographics
NPI:1942175633
Name:RODRIGUEZ, RAYMOND JOSUE
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JOSUE
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 1:197 QUINCY AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2359
Mailing Address - Country:US
Mailing Address - Phone:857-275-9407
Mailing Address - Fax:857-275-9407
Practice Address - Street 1:197 QUINCY AVE STE 111
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2359
Practice Address - Country:US
Practice Address - Phone:857-275-9407
Practice Address - Fax:857-275-9407
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty