Provider Demographics
NPI:1164106266
Name:RAGONESE-ALBERT, NITALIA BRIASIA
Entity Type:Individual
Prefix:
First Name:NITALIA
Middle Name:BRIASIA
Last Name:RAGONESE-ALBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S FRONTAGE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-4684
Mailing Address - Country:US
Mailing Address - Phone:407-577-8570
Mailing Address - Fax:
Practice Address - Street 1:311 S FRONTAGE RD STE 106
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4684
Practice Address - Country:US
Practice Address - Phone:407-577-8570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health