Provider Demographics
NPI:1578583365
Name:AGRAN, PHYLLIS F (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:F
Last Name:AGRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:805 W LA VETA AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3901
Mailing Address - Country:US
Mailing Address - Phone:714-744-0776
Mailing Address - Fax:714-744-6033
Practice Address - Street 1:805 W LA VETA AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3901
Practice Address - Country:US
Practice Address - Phone:714-744-0776
Practice Address - Fax:714-744-6033
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG377252080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G377250Medicaid
CA953842393OtherEMPLOYER ID
CAG37725Medicare ID - Type Unspecified
CA953842393OtherEMPLOYER ID