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General NPI Number Information
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NPI Number | 1104336064
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Entity Type | Organization
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Legal Business Name | DR MARCIA ASGARIAN INC
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 10/05/2017
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Provider Practice Location Address
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Address Line | 755 S FAIRMONT AVE
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City | LODI
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State | CA
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Zip | 95240-4643
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Country | US
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Telephone | 209-625-9409
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2655
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City | LODI
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State | CA
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Zip | 95241-2655
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Country | US
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Telephone | 209-625-9409
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Fax | 844-308-8677
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. FREDERICK ASGARIAN
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Credential | MD
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Telephone | 209-625-9409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 18390
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License Number State | CA
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