Healthcare Provider Details

I. General information

NPI: 1417097098
Provider Name (Legal Business Name): AMIT PARAG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 CAMINO DE LOS MARES SUITE 243
SAN CLEMENTE CA
92673-2826
US

IV. Provider business mailing address

657 CAMINO DE LOS MARES SUITE 243
SAN CLEMENTE CA
92673-2826
US

V. Phone/Fax

Practice location:
  • Phone: 949-661-2455
  • Fax: 949-661-5751
Mailing address:
  • Phone: 949-661-2455
  • Fax: 949-661-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA97392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: