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General NPI Number Information
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NPI Number | 1851440036
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Entity Type | Individual
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Provider Name | MELVIN LAZARO AGATEP M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2503 BEVERLY BLVD STE. #2
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City | LOS ANGELES
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State | CA
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Zip | 90057-1024
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Country | US
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Telephone | 213-368-9283
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Fax | 213-368-0478
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Provider Business Mailing Address
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Address Line | 1171 ALLEN AVE STE. #103
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City | GLENDALE
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State | CA
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Zip | 91201-3330
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Country | US
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Telephone | 818-840-0371
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Fax | 818-840-0371
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A047785
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License Number State | CA
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