Healthcare Provider Details

I. General information

NPI: 1417919366
Provider Name (Legal Business Name): RAMIL AGANA ASCANO PT,MBA,MSM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SUNSET LOOP APT 2
MINOT AFB ND
58704-1905
US

IV. Provider business mailing address

103 SUNSET LOOP
MINOT AFB ND
58704-1905
US

V. Phone/Fax

Practice location:
  • Phone: 701-723-5544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number1020
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: