Healthcare Provider Details

I. General information

NPI: 1508058108
Provider Name (Legal Business Name): RANJANI AGRAWAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 02/06/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20740 SPRUCE CIR
PORTER RANCH CA
91326-4955
US

IV. Provider business mailing address

20740 SPRUCE CIR
PORTER RANCH CA
91326-4955
US

V. Phone/Fax

Practice location:
  • Phone: 323-393-0395
  • Fax:
Mailing address:
  • Phone: 323-393-0395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA103054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: