Healthcare Provider Details

I. General information

NPI: 1033405592
Provider Name (Legal Business Name): ANURAG GOEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 W HENDERSON AVE
PORTERVILLE CA
93257-1490
US

IV. Provider business mailing address

651 N SEPULVEDA BLVD # 2012
LOS ANGELES CA
90049-2185
US

V. Phone/Fax

Practice location:
  • Phone: 559-788-1200
  • Fax:
Mailing address:
  • Phone: 858-386-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number285499
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC148442
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: