Provider Demographics
NPI:1275019085
Name:OHANYAN, AGASI
Entity Type:Individual
Prefix:
First Name:AGASI
Middle Name:
Last Name:OHANYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 SANDHILL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5801
Mailing Address - Country:US
Mailing Address - Phone:916-770-6463
Mailing Address - Fax:
Practice Address - Street 1:1412 SANDHILL DR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5801
Practice Address - Country:US
Practice Address - Phone:916-770-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-15
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8BKM522347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle