Provider Demographics
NPI:1144090002
Name:RAGO, JENNIFER LYNN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:RAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69930 CA-111
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-992-3039
Mailing Address - Fax:
Practice Address - Street 1:54100 PINE CREST AVE UNIT 8
Practice Address - Street 2:
Practice Address - City:IDYLLWILD
Practice Address - State:CA
Practice Address - Zip Code:92549-2621
Practice Address - Country:US
Practice Address - Phone:714-458-0219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician