| Doctor Name: | MS. JACLYN SONIA AGOPIAN |
| NPI Number: | 1053629121 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MPAP, PA-C |
| License Number: | PA21026 |
| Business Practice Address: | 4836 Van Nuys Blvd Sherman Oaks, CA - 914032101 |
| Business Phone Number: | 8189077546 |
| Business Fax Number: | 8189079506 |
| Mailing Address: | 4836 Van Nuys Blvd, SHERMAN OAKS |
| State: | CA |
| Postal Code: | 914032101 |
| Phone Number: | 8189077546 |
| Fax Number: | 8189079506 |
| NPI Enumeration Date: | 09/22/2010 |
| NPI Last Update Date: | 11/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA21026 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |