Healthcare Provider Details

I. General information

NPI: 1922134204
Provider Name (Legal Business Name): AGP MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 W 115TH ST
LOS ANGELES CA
90044-4112
US

IV. Provider business mailing address

169 E 36TH ST
LONG BEACH CA
90807-3852
US

V. Phone/Fax

Practice location:
  • Phone: 562-492-5994
  • Fax:
Mailing address:
  • Phone: 562-492-5994
  • Fax: 310-649-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PROF. VERRETTA DEOROSAN
Title or Position: OWNER
Credential: M.D.
Phone: 562-492-5994