Provider Demographics
NPI:1093711749
Name:ARGUN, ABRAHAM A (PSY)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:A
Last Name:ARGUN
Suffix:
Gender:M
Credentials:PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4354 LATHAM ST STE 100
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-1777
Mailing Address - Country:US
Mailing Address - Phone:951-683-0650
Mailing Address - Fax:951-774-4610
Practice Address - Street 1:4354 LATHAM ST STE 100
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1777
Practice Address - Country:US
Practice Address - Phone:951-683-0650
Practice Address - Fax:951-774-4610
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11922103TF0200X, 103TR0400X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPL119222Medicare ID - Type Unspecified
CAW31899Medicare UPIN