Provider Demographics
NPI:1861456501
Name:RAMOS, RODOLFO MANGUBAT JR (MD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:MANGUBAT
Last Name:RAMOS
Suffix:JR
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 1:2025 OAK PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7827
Mailing Address - Country:US
Mailing Address - Phone:337-478-2573
Mailing Address - Fax:337-478-5296
Practice Address - Street 1:2025 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7827
Practice Address - Country:US
Practice Address - Phone:337-478-2573
Practice Address - Fax:337-478-5296
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10998R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA10998RMedicaid
LA10998RMedicaid
F95228Medicare UPIN