Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RX0202X | Medical Oncology | 036-118071 | IL |
Y | 207RX0202X | Medical Oncology | C170270 | CA |
NPI | 1164448734 |
---|---|
Provider Name | Mark Agulnik |
First Address | Los Angeles, CA 90051-0185 |
Second Address | Duarte, CA 91010-3012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 28/10/2020 |