Healthcare Provider Details

I. General information

NPI: 1093711749
Provider Name (Legal Business Name): ABRAHAM A ARGUN PSY.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4354 LATHAM ST STE 100
RIVERSIDE CA
92501-1777
US

IV. Provider business mailing address

4354 LATHAM ST STE 100
RIVERSIDE CA
92501-1777
US

V. Phone/Fax

Practice location:
  • Phone: 951-683-0650
  • Fax: 951-774-4610
Mailing address:
  • Phone: 951-683-0650
  • Fax: 951-774-4610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY11922
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSY11922
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY11922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: