=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114064714
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARAG MEDICAL, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 06/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 657 CAMINO DE LOS MARES SUITE 243
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92673-2811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-661-2455
-----------------------------------------------------
Fax | 949-661-5751
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 657 CAMINO DE LOS MARES SUITE 243
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92673-2811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-661-2455
-----------------------------------------------------
Fax | 949-661-5751
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | AMIT PARAG
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 949-661-2455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A97392
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------