Provider Demographics
NPI:1518063510
Name:BAGHDASSARIAN, RUBEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
Last Name:BAGHDASSARIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3791 KATELLA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3105
Mailing Address - Country:US
Mailing Address - Phone:562-598-6166
Mailing Address - Fax:562-799-8210
Practice Address - Street 1:3791 KATELLA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3105
Practice Address - Country:US
Practice Address - Phone:562-598-6166
Practice Address - Fax:562-799-8210
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38697208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A386970Medicaid
CAWA38697CMedicare PIN
CAWA38697BMedicare PIN
CAA85163Medicare UPIN
CA00A386970Medicaid