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General NPI Number Information
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NPI Number | 1134793649
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Entity Type | Organization
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Legal Business Name | AG PAIN MANAGEMENT TX, INC
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 218 W NASA PKWY STE A
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City | WEBSTER
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State | TX
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Zip | 77598-5393
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Country | US
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Telephone | 281-505-5680
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Fax |
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Provider Business Mailing Address
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Address Line | 1687 ERRINGER RD STE 217
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City | SIMI VALLEY
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State | CA
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Zip | 93065-6510
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Country | US
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Telephone | 281-505-5680
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. AMIT GUPTA
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Credential | D.O.
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Telephone | 281-505-5680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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