1215067194 NPI number — MS. RUZANNA AGAMYAN PHD UNLICENSED

Table of content: MS. RUZANNA AGAMYAN PHD UNLICENSED (NPI 1215067194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215067194 NPI number — MS. RUZANNA AGAMYAN PHD UNLICENSED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGAMYAN
Provider First Name:
RUZANNA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHD UNLICENSED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215067194
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 E ANGELENO AVE UNIT 403
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURBANK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91502-2956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-415-2058
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3208 ROSEMEAD BLVD
Provider Second Line Business Practice Location Address:
ENKI
Provider Business Practice Location Address City Name:
EL MONTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-227-7001
Provider Business Practice Location Address Fax Number:
626-227-7002
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  21548 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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