Provider Demographics
NPI:1578715181
Name:AGARWAL, ANSHU (PSY D)
Entity Type:Individual
Prefix:DR
First Name:ANSHU
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 LEGGETT LN
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-1532
Mailing Address - Country:US
Mailing Address - Phone:714-366-6718
Mailing Address - Fax:
Practice Address - Street 1:3208 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2830
Practice Address - Country:US
Practice Address - Phone:626-227-7001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23604103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical