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General NPI Number Information
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NPI Number | 1568530087
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Entity Type | Individual
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Provider Name | RAQUEL MANUEL RPA-C
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 01/27/2016
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Provider Practice Location Address
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Address Line | 77A ROUTE 25A
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City | ROCKY POINT
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State | NY
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Zip | 11778-8881
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Country | US
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Telephone | 631-849-6363
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Fax |
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Provider Business Mailing Address
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Address Line | 86 CURTIS DR
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City | SOUND BEACH
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State | NY
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Zip | 11789-2213
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Country | US
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Telephone | 631-849-5447
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 007033-1
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License Number State | NY
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