Basic Information
Provider Information
NPI: 1811284771
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAGASA
FirstName: IMELDA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 33255 9TH ST
Address2:  
City: UNION CITY
State: CA
PostalCode: 945872137
CountryCode: US
TelephoneNumber: 5104715880
FaxNumber: 5104719051
Practice Location
Address1: 33255 9TH ST
Address2:  
City: UNION CITY
State: CA
PostalCode: 945872137
CountryCode: US
TelephoneNumber: 5104715880
FaxNumber: 5104719051
Other Information
ProviderEnumerationDate: 06/29/2011
LastUpdateDate: 06/29/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WC1500X696465CAY Nursing Service ProvidersRegistered NurseCommunity Health

No ID Information.


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