Provider Demographics
NPI:1487253860
Name:CALAGUAS, RONALD JINGCO
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:JINGCO
Last Name:CALAGUAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 W PORTOBELLO AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7871
Mailing Address - Country:US
Mailing Address - Phone:480-793-7971
Mailing Address - Fax:480-793-7971
Practice Address - Street 1:2432 W PORTOBELLO AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7871
Practice Address - Country:US
Practice Address - Phone:480-793-7971
Practice Address - Fax:480-793-7971
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3104A0630X, 3104A0625X
AZAL11467H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAL11467HOtherAL LICENSE