Healthcare Provider Details

I. General information

NPI: 1821397381
Provider Name (Legal Business Name): DAWN RAGO-ROSE MSN,RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 05/29/2021
Certification Date: 05/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 KILROY AIRPORT WAY
LONG BEACH CA
90806-2494
US

IV. Provider business mailing address

4618 FOUNTAIN AVE
LOS ANGELES CA
90029-1977
US

V. Phone/Fax

Practice location:
  • Phone: 855-667-7226
  • Fax:
Mailing address:
  • Phone: 323-953-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: