Basic Information
| Provider Information | |||||||||
| NPI: | 1265962534 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICHY AGAJANIAN M.D. A PROFESSIONAL CORP. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18000 STUDEBAKER RD STE 800 | ||||||||
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| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907032679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627353226 | ||||||||
| FaxNumber: | 5628691281 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 W SAINT MARYS RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857452621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203914320 | ||||||||
| FaxNumber: | 5203914362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2017 | ||||||||
| LastUpdateDate: | 10/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | AGAJANIAN | ||||||||
| AuthorizedOfficialFirstName: | HILDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5627353226 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RICHY AGAJANIAN MD A PROFESSIONAL CORPORATION | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
| NPICertificationDate: | 10/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 45450 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.