Provider Demographics
NPI:1023328630
Name:RAGO, JUNA ASILO (PT)
Entity type:Individual
Prefix:MISS
First Name:JUNA
Middle Name:ASILO
Last Name:RAGO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5107
Mailing Address - Country:US
Mailing Address - Phone:718-769-2521
Mailing Address - Fax:718-646-1119
Practice Address - Street 1:3500 NOSTRAND AVE.
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-769-2521
Practice Address - Fax:718-646-1911
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist