1053886226 NPI number — ROSEMARY K RAGUSA IBCLC

Table of content: ROSEMARY K RAGUSA IBCLC (NPI 1053886226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053886226 NPI number — ROSEMARY K RAGUSA IBCLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAGUSA
Provider First Name:
ROSEMARY
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
IBCLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053886226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11567 SE POWELL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97266-1762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-313-2427
Provider Business Mailing Address Fax Number:
971-417-2112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11567 SE POWELL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97266-1762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-313-2427
Provider Business Practice Location Address Fax Number:
971-417-2112
Provider Enumeration Date:
10/03/2018

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: 174N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: L-143482 . This is a "IBCLE" identifier . This identifiers is of the category "OTHER".




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