Provider Demographics
NPI:1265660484
Name:NAGEOTTE, RYAN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOSEPH
Last Name:NAGEOTTE
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 1:4242 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-1924
Mailing Address - Country:US
Mailing Address - Phone:562-427-3561
Mailing Address - Fax:
Practice Address - Street 1:4242 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-1924
Practice Address - Country:US
Practice Address - Phone:562-427-3561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114682207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology