Agena, Tara Rithaporn

Agena, Tara Rithaporn is an individual health care provider with primary practice located at 565 N Mount Vernon Ave , San Bernardino CA 92411-2661. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Agena, Tara Rithaporn can be contacted via phone (909) 884-9091.

Contact Information

Primary practice address
565 N Mount Vernon Ave San Bernardino CA 92411-2661
Phone: (909) 884-9091
Fax: (909) 383-7013
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X A97352 California

Profile Details

NPI number 1629249859
LBN Legal business name Agena, Tara Rithaporn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 15th, 2008
Last updated Nov 29th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629249859 NPPES
California MEDICAID 00A973520

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