Provider Demographics
NPI:1285242974
Name:RAGASA, NORMA TOMAS
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:TOMAS
Last Name:RAGASA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 KEALOHILANI ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3128
Mailing Address - Country:US
Mailing Address - Phone:808-877-4770
Mailing Address - Fax:
Practice Address - Street 1:156 KEALOHILANI ST
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3128
Practice Address - Country:US
Practice Address - Phone:808-877-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-19
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI510835Medicaid