Provider Demographics
NPI:1215035274
Name:ISKAROUS, RAGAA (MD)
Entity type:Individual
Prefix:DR
First Name:RAGAA
Middle Name:
Last Name:ISKAROUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11003 LAKEWOOD BLVD
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3809
Mailing Address - Country:US
Mailing Address - Phone:562-869-1038
Mailing Address - Fax:
Practice Address - Street 1:11003 LAKEWOOD BLVD
Practice Address - Street 2:SUITE # 201
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3809
Practice Address - Country:US
Practice Address - Phone:562-869-1038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A451550Medicaid
CAA45155Medicare ID - Type Unspecified
CA00A451550Medicaid