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RYAN HIDEO AGENA MD

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1891877395

Individual Registrant:
 RYAN HIDEO AGENA MD
Gender: M
Not Sole Proprietor

Location and contact information for practice:
3110 CHINO AVE # 150 A CHINO HILLS, CA 91709-1211 US
Tel: 909-630-7490  Fax: 909-630-7491

Contact information for business:
12841 WILD HORSE WAY  RANCHO CUCAMONGA, CA 91739-8837 US
Tel: 909-630-7490  Fax: 909-630-7491

Registration Information:
NPI: 1891877395
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
CA20A9676

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
CAQH1174467901
DEABA998303701




HEALTH CARE JOBS CA - Page 1



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