Healthcare Provider Details

I. General information

NPI: 1477820447
Provider Name (Legal Business Name): ANTONY MINASAGHANIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 06/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BUILDING 56, SUITE 300A
ORANGE CA
92868-3201
US

IV. Provider business mailing address

1400 E CHURCH ST
SANTA MARIA CA
93454-5906
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-6595
  • Fax:
Mailing address:
  • Phone: 714-456-6595
  • Fax: 714-456-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA123878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: