Healthcare Provider Details

I. General information

NPI: 1972196111
Provider Name (Legal Business Name): RISHI AGARWAL, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
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

10838 CALLE BELLA
RIVERSIDE CA
92503-5267
US

V. Phone/Fax

Practice location:
  • Phone: 951-809-1323
  • Fax:
Mailing address:
  • Phone: 951-809-1323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RISHI RAJ AGARWAL
Title or Position: PRESIDENT
Credential: MD
Phone: 951-809-1323