Healthcare Provider Details

I. General information

NPI: 1316289929
Provider Name (Legal Business Name): PRITI NAGNUR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 06/26/2021
Certification Date: 06/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W CHASE AVE
EL CAJON CA
92020-5710
US

IV. Provider business mailing address

823 GATEWAY CENTER WAY
SAN DIEGO CA
92102-4541
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2499
  • Fax:
Mailing address:
  • Phone: 619-515-2300
  • Fax: 619-906-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA09922100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA170055
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: