Provider Demographics
NPI:1124041710
Name:MOGADAS, RAMIN R (MD)
Entity Type:Individual
Prefix:
First Name:RAMIN
Middle Name:R
Last Name:MOGADAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 OROVILLE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0923
Mailing Address - Country:US
Mailing Address - Phone:909-532-0609
Mailing Address - Fax:
Practice Address - Street 1:9985 SIERRA AVE FL MOB
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:909-427-2072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA930302080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A930300Medicaid
I46931Medicare UPIN
00A930300Medicare ID - Type Unspecified