Healthcare Provider Details

I. General information

NPI: 1417342981
Provider Name (Legal Business Name): DEEPAK AGARWAL D.O M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 02/14/2021
Certification Date: 02/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W PUEBLO ST STE B
SANTA BARBARA CA
93105-3805
US

IV. Provider business mailing address

10989 BLUFFSIDE DR APT 3106
STUDIO CITY CA
91604-4406
US

V. Phone/Fax

Practice location:
  • Phone: 805-563-0363
  • Fax:
Mailing address:
  • Phone: 614-634-6377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A19239
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number20A18239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: