Healthcare Provider Details

I. General information

NPI: 1699169821
Provider Name (Legal Business Name): RAQUEL SUGINO DPM, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 NE TUDOR RD
LEES SUMMIT MO
64086-5696
US

IV. Provider business mailing address

224 NE TUDOR RD
LEES SUMMIT MO
64086-5696
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-4778
  • Fax: 816-525-5761
Mailing address:
  • Phone: 816-525-4778
  • Fax: 816-525-5761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: