Provider Demographics
NPI:1457430399
Name:BOUZAGLOU, ARMAND (MD)
Entity Type:Individual
Prefix:DR
First Name:ARMAND
Middle Name:
Last Name:BOUZAGLOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10226 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2874
Mailing Address - Country:US
Mailing Address - Phone:263-316-8666
Mailing Address - Fax:626-331-6773
Practice Address - Street 1:10226 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2874
Practice Address - Country:US
Practice Address - Phone:626-331-6866
Practice Address - Fax:626-331-6773
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00681572085R0001X, 2471R0002X
CAHG260982085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G260981Medicaid
CAA42900Medicare UPIN
CAWG26098QMedicare UPIN