Healthcare Provider Details

I. General information

NPI: 1902177470
Provider Name (Legal Business Name): AG PAIN MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2012
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 ERRINGER ROAD # 217
SIMI VALLEY CA
93065
US

IV. Provider business mailing address

1687 ERRINGER ROAD # 217
SIMI VALLEY CA
93065
US

V. Phone/Fax

Practice location:
  • Phone: 805-526-1700
  • Fax: 805-512-7880
Mailing address:
  • Phone: 805-526-1700
  • Fax: 805-512-7880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number20A11210
License Number StateCA

VIII. Authorized Official

Name: DR. AMIT GUPTA
Title or Position: PHYSICIAN/OWNER
Credential: DO
Phone: 619-227-2353