MEDICARE: JOSE ANGELO RAGON VASQUEZ D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	54036	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770613598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE ANGELO RAGON VASQUEZ D.D.S.

Provider Business Mailing Address
First Line	:	2420 VISTA WAY STE 210
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6190
Country	:	US
Telephone Number	:	760-724-1102
Fax Number	:	760-724-1471

Provider Business Practice Location Address
First Line	:	2420 VISTA WAY STE 210
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6190
Country	:	US
Telephone Number	:	760-724-1102
Fax Number	:	760-724-1471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	12/21/2018

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