Provider Demographics
NPI:1942694625
Name:HASAN, RAGDA
Entity Type:Individual
Prefix:
First Name:RAGDA
Middle Name:
Last Name:HASAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RAGHDAA
Other - Middle Name:
Other - Last Name:HASSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4319 STAR RUBY BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-1611
Mailing Address - Country:US
Mailing Address - Phone:561-452-7312
Mailing Address - Fax:
Practice Address - Street 1:4319 STAR RUBY BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-1611
Practice Address - Country:US
Practice Address - Phone:561-452-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9491979163W00000X
FL77447225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse