Provider Demographics
NPI:1790929206
Name:AGHAPY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:AGHAPY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ATA
Authorized Official - Middle Name:O
Authorized Official - Last Name:MEHRTASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-531-3331
Mailing Address - Street 1:12954 HAWTHORNE BLVD
Mailing Address - Street 2:101
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-4418
Mailing Address - Country:US
Mailing Address - Phone:310-219-1550
Mailing Address - Fax:310-219-0723
Practice Address - Street 1:12954 HAWTHORNE BLVD
Practice Address - Street 2:101
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4418
Practice Address - Country:US
Practice Address - Phone:310-219-1550
Practice Address - Fax:310-219-0723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790929206Medicaid
CA1790929206Medicaid