Provider Demographics
NPI:1366270621
Name:AGANYA, MARK (PMHNP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:AGANYA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-0392
Mailing Address - Country:US
Mailing Address - Phone:888-848-4368
Mailing Address - Fax:559-423-5104
Practice Address - Street 1:1401 21ST ST # 5723
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-5226
Practice Address - Country:US
Practice Address - Phone:888-848-4364
Practice Address - Fax:559-423-5104
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ315350363LP0808X
CA95031314363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health