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1831573005 NPI number — DRISTHI S RAGOONANAN M.D/M.B.B.S

NPI Number: 1831573005
Health Care Provider/Practitioner: DRISTHI S RAGOONANAN M.D/M.B.B.S

Information about “1831573005” NPI (DRISTHI S RAGOONANAN M.D/M.B.B.S) exists in 1831573005 in HTML format HTML  |  1831573005 in plain Text format TXT  |  1831573005 in PDF (Portable Document Format) PDF  |  1831573005 in an XML format XML  formats.

NPI Number : 1831573005 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1831573005",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RAGOONANAN",
    "FirstName": "DRISTHI",
    "MiddleName": "S",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D/M.B.B.S",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10170 W TROPICANA AVE # 156-252",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAS VEGAS",
    "MailingAddressStateName": "NV",
    "MailingAddressPostalCode": "89147-8465",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "702-732-1493",
    "MailingAddressFaxNumber": "702-732-1080",
    "FirstLinePracticeLocationAddress": "1 BREAKTHROUGH WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAS VEGAS",
    "PracticeLocationAddressStateName": "NV",
    "PracticeLocationAddressPostalCode": "89135-3011",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "702-732-1493",
    "PracticeLocationAddressFaxNumber": "702-732-1080",
    "EnumerationDate": "07/16/2015",
    "LastUpdateDate": "08/27/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2080P0207X",
          "TaxonomyName": "Pediatric Hematology & Oncology Physician",
          "LicenseNumber": "T7010",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2080P0207X",
          "TaxonomyName": "Pediatric Hematology & Oncology Physician",
          "LicenseNumber": "26156",
          "LicenseNumberStateCode": "NV",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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