Provider Demographics
NPI:1851440036
Name:AGATEP, MELVIN LAZARO (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:LAZARO
Last Name:AGATEP
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1171 ALLEN AVE
Mailing Address - Street 2:STE. #103
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3330
Mailing Address - Country:US
Mailing Address - Phone:818-840-0371
Mailing Address - Fax:818-840-0371
Practice Address - Street 1:2503 BEVERLY BLVD
Practice Address - Street 2:STE. #2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1024
Practice Address - Country:US
Practice Address - Phone:213-368-9283
Practice Address - Fax:213-368-0478
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA047785207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A477850Medicaid
CA00A477850Medicaid
CAF93399Medicare UPIN