MEDICARE: HRIPSIME AVAGYAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	20A15266	CA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	20A15266	CA

General Provider Information

NPI Number	:	1790122687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HRIPSIME AVAGYAN D.O.

Provider Business Mailing Address
First Line	:	3300 FOOTHILL BLVD UNIT 12359
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91224-7042
Country	:	US
Telephone Number	:	747-277-4555
Fax Number	:

Provider Business Practice Location Address
First Line	:	7640 TAMPA AVE STE 106B
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-1713
Country	:	US
Telephone Number	:	747-277-4555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2013
Last Update Date	:	02/01/2022

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