Provider Demographics
NPI:1326230822
Name:RAGEN, MICHAEL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:RAGEN
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 1:3801 LAS POSAS RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1427
Mailing Address - Country:US
Mailing Address - Phone:805-388-1211
Mailing Address - Fax:805-388-0900
Practice Address - Street 1:3801 LAS POSAS RD
Practice Address - Street 2:SUITE 112
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1427
Practice Address - Country:US
Practice Address - Phone:805-388-1211
Practice Address - Fax:805-388-0900
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN3235738174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G586480Medicaid
CAE02854Medicare UPIN
CA00G586480Medicaid
CAWG58648DMedicare PIN