Provider Demographics
NPI:1073668166
Name:RAGASA, LEILANI RAQUEPO (MD)
Entity Type:Individual
Prefix:
First Name:LEILANI
Middle Name:RAQUEPO
Last Name:RAGASA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEILANI
Other - Middle Name:RAGASA
Other - Last Name:RAQUEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2829 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3304
Mailing Address - Country:US
Mailing Address - Phone:213-744-3915
Mailing Address - Fax:213-744-3944
Practice Address - Street 1:2829 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3304
Practice Address - Country:US
Practice Address - Phone:213-744-3915
Practice Address - Fax:213-744-3944
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54981261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG19555Medicare UPIN