Healthcare Provider Details

I. General information

NPI: 1932731650
Provider Name (Legal Business Name): RAQUEL ALEJANDRA RODRIGUEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 MARKET ST # A
LAREDO TX
78040-6253
US

IV. Provider business mailing address

1104 MARKET ST # A
LAREDO TX
78040-6253
US

V. Phone/Fax

Practice location:
  • Phone: 956-229-3414
  • Fax: 956-441-1858
Mailing address:
  • Phone: 956-229-3414
  • Fax: 956-441-1858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RAQUEL ALEJANDRA RODRIGUEZ
Title or Position: OWNER/ ADMINISTRATOR
Credential:
Phone: 956-229-3414