Healthcare Provider Details

I. General information

NPI: 1164708657
Provider Name (Legal Business Name): DR. RAGY S GERGIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W PARKRIDGE AVE
CORONA CA
92880-1450
US

IV. Provider business mailing address

664 AVONDALE DR
CORONA CA
92879-8556
US

V. Phone/Fax

Practice location:
  • Phone: 951-278-1852
  • Fax:
Mailing address:
  • Phone: 909-395-7528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number59000
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number59000
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number59000
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number59000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: