Basic Information
| Provider Information | |||||||||
| NPI: | 1780263731 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROGERO | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | GERALD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1134 CHATEAU CT | ||||||||
| Address2: | |||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952429166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2097121401 | ||||||||
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| Practice Location | |||||||||
| Address1: | 920 MADISON AVE STE 447 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381033438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017593275 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2021 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.