Healthcare Provider Details

I. General information

NPI: 1659634798
Provider Name (Legal Business Name): RISHI RAJ AGARWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N MARENGO AVE STE 115
PASADENA CA
91101-1560
US

IV. Provider business mailing address

300 E BELLEVUE DR APT 304
PASADENA CA
91101-3106
US

V. Phone/Fax

Practice location:
  • Phone: 626-514-1188
  • Fax:
Mailing address:
  • Phone: 951-809-1323
  • Fax: 626-322-2687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME143275
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number80330
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA126641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: