Healthcare Provider Details

I. General information

NPI: 1275019085
Provider Name (Legal Business Name): AGASI OHANYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2018
Last Update Date: 07/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 SANDHILL DR
ROCKLIN CA
95765-5801
US

IV. Provider business mailing address

1412 SANDHILL DR
ROCKLIN CA
95765-5801
US

V. Phone/Fax

Practice location:
  • Phone: 916-770-6463
  • Fax:
Mailing address:
  • Phone: 916-770-6463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number8BKM522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: