Provider Demographics
NPI:1790122687
Name:AVAGYAN, HRIPSIME (DO)
Entity Type:Individual
Prefix:
First Name:HRIPSIME
Middle Name:
Last Name:AVAGYAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 FOOTHILL BLVD UNIT 12359
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91224-7042
Mailing Address - Country:US
Mailing Address - Phone:747-277-4555
Mailing Address - Fax:
Practice Address - Street 1:7640 TAMPA AVE STE 106B
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1713
Practice Address - Country:US
Practice Address - Phone:747-277-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15266207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology