1528083383 NPI number — HARIHAR P. AGARWAL, MD INC

Table of content: (NPI 1528083383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528083383 NPI number — HARIHAR P. AGARWAL, MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARIHAR P. AGARWAL, MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1528083383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1359 W AVENUE J
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93534-2935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-726-5000
Provider Business Mailing Address Fax Number:
661-726-4347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1363 W AVENUE J
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-2935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-726-5000
Provider Business Practice Location Address Fax Number:
661-726-4347
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AGARWAL
Authorized Official First Name:
HARI
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
661-726-5000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  G462460 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: A455310 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: G462460 , 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)

  • Identifier: 110132636 . This is a "RR MCARE DR CHHAYA INDIV" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G462460 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CD2403 . This is a "RR MEDICARE GROUP #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D0725255 . This is a "CLIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G462460 . This is a "MEDICAL LICENSE DR HARI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0079280 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ64543Z . This is a "BLUE SHIELD GROUP ID#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 110132635 . This is a "RR MCARE DR HARI INDIVIDU" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A455310 . This is a "MEDICAL LICENSE DR CHHAYA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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