MEDICARE: DR. HOSSAIN ALI RONAGHY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	C39525	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386670438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOSSAIN ALI RONAGHY M.D.

Provider Business Mailing Address
First Line	:	3023 BUNKER HILL ST
Second Line	:	#106
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-5706
Country	:	US
Telephone Number	:	619-275-2700
Fax Number	:	858-270-0011

Provider Business Practice Location Address
First Line	:	3023 BUNKER HILL ST
Second Line	:	#106
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-5706
Country	:	US
Telephone Number	:	619-275-2700
Fax Number	:	858-270-0011

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	07/09/2007

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