Individual
JOSE IVAN RAGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
287 E. HUNT HIGHWAY, SUITE 105, SAN TAN VALLEY, AZ 85143-5096
(480) 677-8282
(480) 677-8283
Mailing address
8125 N HAYDEN RD, SCOTTSDALE, AZ 85258-2463
(623) 584-1181
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
42140
AZ
390200000X
Student in an Organized Health Care Education/Training Program
R70138
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477714137
MEDICARE-NPI
AZ
05
—
463254
—
AZ
Enumeration date
06/24/2008
Last updated
12/03/2019
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