1366763328 NPI number — HANK AARON RAGANIT LABARCON RPH

Table of content: HANK AARON RAGANIT LABARCON RPH (NPI 1366763328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366763328 NPI number — HANK AARON RAGANIT LABARCON RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LABARCON
Provider First Name:
HANK AARON
Provider Middle Name:
RAGANIT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

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:
1366763328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 NOVA ALBION WAY
Provider Second Line Business Mailing Address:
329
Provider Business Mailing Address City Name:
SAN RAFAEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94903-3508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-717-5566
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 NORTHGATE MALL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN RAFAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94903-3671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-492-0888
Provider Business Practice Location Address Fax Number:
415-492-0551
Provider Enumeration Date:
06/14/2010

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: 183500000X , with the licence number:  61003 , 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)





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