Healthcare Provider Details

I. General information

NPI: 1265962534
Provider Name (Legal Business Name): RICHY AGAJANIAN M.D. A PROFESSIONAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W SAINT MARYS RD STE 100
TUCSON AZ
85745-2621
US

IV. Provider business mailing address

18000 STUDEBAKER RD STE 800
CERRITOS CA
90703-2679
US

V. Phone/Fax

Practice location:
  • Phone: 520-391-4320
  • Fax: 520-391-4362
Mailing address:
  • Phone: 562-735-3226
  • Fax: 562-869-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number45450
License Number StateAZ

VIII. Authorized Official

Name: HILDA AGAJANIAN
Title or Position: ADMINISTRATOR
Credential: MBA
Phone: 562-735-3226