1124214382 NPI number — RAGNA C. ROSTAD-RUFFNER P.A.

Table of content: RAGNA C. ROSTAD-RUFFNER P.A. (NPI 1124214382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124214382 NPI number — RAGNA C. ROSTAD-RUFFNER P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSTAD-RUFFNER
Provider First Name:
RAGNA
Provider Middle Name:
C.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUFFNER
Provider Other First Name:
RAGNA
Provider Other Middle Name:
C.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124214382
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1531 ESPLANADE
Provider Second Line Business Mailing Address:
ATTN: FINANCE
Provider Business Mailing Address City Name:
CHICO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95926-3310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-332-7479
Provider Business Mailing Address Fax Number:
530-893-6853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
888 LAKESIDE VLG COMMONS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95928-3979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-332-6816
Provider Business Practice Location Address Fax Number:
530-893-6856
Provider Enumeration Date:
09/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA19364 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PA19364 . This is a "PHYSICIAN ASSIST LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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