1447351085 NPI number — PARAG AGNIHOTRI M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447351085 NPI number — PARAG AGNIHOTRI M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

AGNIHOTRI

Provider First Name:

PARAG

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1447351085

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/26/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 232410

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SAN DIEGO

Provider Business Mailing Address State Name:

CA

Provider Business Mailing Address Postal Code:

92193-2410

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

200 W ARBOR DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SAN DIEGO

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

92103

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

800-926-8273

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

09/26/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  C52218 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RG0300X , with the licence number: C52218 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 000810783729 . This is a "PHCS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 00C522180 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 90204087 . This is a "PACIFICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: G33106 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: MCMG465400 . This is a "WESTERN HEALTH ADVANTAGE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 1907932 . This is a "CIGNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 5466247 . This is a "FIRST HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 131552 . This is a "HEALTH NET" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 2049274 . This is a "GREAT WEST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 311160 . This is a "INTERPLAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 7228180 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".