Provider Demographics
NPI:1073649612
Name:AGILENCE ARTHRITIS AND OSTEOPOROSIS MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:AGILENCE ARTHRITIS AND OSTEOPOROSIS MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:562-945-7252
Mailing Address - Street 1:12291 WASHINGTON BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-2500
Mailing Address - Country:US
Mailing Address - Phone:562-945-7252
Mailing Address - Fax:562-945-0122
Practice Address - Street 1:12291 WASHINGTON BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2500
Practice Address - Country:US
Practice Address - Phone:562-945-7252
Practice Address - Fax:562-945-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092590Medicaid
CAGR0092590Medicaid