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General NPI Number Information
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NPI Number | 1215067194
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Entity Type | Individual
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Provider Name | RUZANNA AGAMYAN PHD UNLICENSED
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 3208 ROSEMEAD BLVD ENKI
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City | EL MONTE
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State | CA
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Zip | 91731
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Country | US
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Telephone | 626-227-7001
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Fax | 626-227-7002
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Provider Business Mailing Address
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Address Line | 201 E ANGELENO AVE UNIT 403
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City | BURBANK
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State | CA
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Zip | 91502-2956
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Country | US
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Telephone | 818-415-2058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 21548
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License Number State | CA
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