Healthcare Provider Details

I. General information

NPI: 1598729501
Provider Name (Legal Business Name): ROGER V. OHANESIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24401 CALLE DE LA LOUISA SUITE 300
LAGUNA HILLS CA
92653-3623
US

IV. Provider business mailing address

675 DIAMOND ST
LAGUNA BEACH CA
92651-3405
US

V. Phone/Fax

Practice location:
  • Phone: 949-951-2020
  • Fax: 949-951-9244
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC31964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: