=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821528118
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGAR NEUROPSYCHOLOGY GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19712 MACARTHUR BLVD STE 110
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92612-2407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-855-2427
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2621 GREEN RIVER RD STE 105-301
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92882-7433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-855-2427
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. C AGAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 866-855-2427
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------