Provider Demographics
NPI:1518554674
Name:JANUARY CLINIC, P.A.
Entity Type:Organization
Organization Name:JANUARY CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HALEH
Authorized Official - Middle Name:
Authorized Official - Last Name:AGDASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-901-1741
Mailing Address - Street 1:1259 EL CAMINO REAL # 231
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4208
Mailing Address - Country:US
Mailing Address - Phone:561-901-1741
Mailing Address - Fax:
Practice Address - Street 1:1259 EL CAMINO REAL # 231
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4208
Practice Address - Country:US
Practice Address - Phone:561-901-1741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-23
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty