Provider Demographics
NPI:1821528118
Name:AGAR NEUROPSYCHOLOGY GROUP, INC.
Entity Type:Organization
Organization Name:AGAR NEUROPSYCHOLOGY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:
Authorized Official - Last Name:AGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-855-2427
Mailing Address - Street 1:2621 GREEN RIVER RD STE 105-301
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7433
Mailing Address - Country:US
Mailing Address - Phone:866-855-2427
Mailing Address - Fax:
Practice Address - Street 1:19712 MACARTHUR BLVD STE 110
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2407
Practice Address - Country:US
Practice Address - Phone:866-855-2427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty