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General NPI Number Information
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NPI Number | 1598553331
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Entity Type | Organization
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Legal Business Name | AGAVE MEDICAL CA PC
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 16397 ROAD 37
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City | MADERA
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State | CA
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Zip | 93636-8224
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Country | US
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Telephone | 929-209-6109
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Fax |
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Provider Business Mailing Address
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Address Line | 359 5TH ST UNIT 3
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City | JERSEY CITY
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State | NJ
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Zip | 07302-2329
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Country | US
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Telephone | 929-209-6109
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ORI FRUHAUF
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Credential |
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Telephone | 551-302-1794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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