Healthcare Provider Details

I. General information

NPI: 1538038989
Provider Name (Legal Business Name): AGAPE MEDICAL GROUP WEST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 SANTA MONICA BLVD FL 2
WEST HOLLYWOOD CA
90069-4496
US

IV. Provider business mailing address

1301 N BROADWAY # 32260
LOS ANGELES CA
90012-1408
US

V. Phone/Fax

Practice location:
  • Phone: 877-894-5415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: BAILEY RENGER
Title or Position: OPERATIONS ADMINISTRATOR
Credential:
Phone: 877-894-5415