MEDICARE: RUBEN RAFAELOVICH AVAGIMOV MD

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	207Q00000X	Family Medicine Physician	A78851	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	:	1558376947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBEN RAFAELOVICH AVAGIMOV MD

Provider Business Mailing Address
First Line	:	PO BOX 5157
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92412-5157
Country	:	US
Telephone Number	:	909-580-6240
Fax Number	:	909-580-6308

Provider Business Practice Location Address
First Line	:	400 N PEPPER AVE
Second Line	:	ARROWHEAD REGIONAL MEDICAL CENTER
City	:	COLTON
State	:	CA
Zip	:	92324-1819
Country	:	US
Telephone Number	:	909-580-6240
Fax Number	:	909-580-6308

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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