Provider Demographics
NPI:1124087127
Name:RAUDA, ROBERTO
Entity type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:RAUDA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ROBERTO
Other - Middle Name:
Other - Last Name:RAUDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CERTIFIED MIDWIFE
Mailing Address - Street 1:8801 RUTLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7933
Mailing Address - Country:US
Mailing Address - Phone:718-791-4647
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001241-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife