Provider Demographics
NPI:1104336064
Name:DR MARCIA ASGARIAN INC
Entity type:Organization
Organization Name:DR MARCIA ASGARIAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ASGARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-625-9409
Mailing Address - Street 1:PO BOX 2655
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-2655
Mailing Address - Country:US
Mailing Address - Phone:209-625-9409
Mailing Address - Fax:844-308-8677
Practice Address - Street 1:755 S FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-4643
Practice Address - Country:US
Practice Address - Phone:209-625-9409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18390103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063636645OtherPSYCHOLOGIST