Provider Demographics
NPI:1568532661
Name:AGONAFIR, BIZUAYEHU (MD)
Entity Type:Individual
Prefix:
First Name:BIZUAYEHU
Middle Name:
Last Name:AGONAFIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23206 LYONS AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2667
Mailing Address - Country:US
Mailing Address - Phone:661-255-1516
Mailing Address - Fax:551-255-1517
Practice Address - Street 1:23206 LYONS AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2667
Practice Address - Country:US
Practice Address - Phone:661-255-1516
Practice Address - Fax:551-255-1517
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38422207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOC38422OMedicaid
CAC38422Medicare ID - Type Unspecified
CAOOC38422OMedicaid