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NPI Code Detail

MEDICARE: AGILE OCCUPATIONAL MEDICINE, PC

MEDICARE: AGILE OCCUPATIONAL MEDICINE, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QX0100XOccupational Medicine Clinic/Center

General Provider Information

NPI Number : 1043901077
Entity Type Code : Organization
Provider Name (Legal Business Name) : AGILE OCCUPATIONAL MEDICINE, PC
Provider Business Mailing Address
First Line : 3200 BRISTOL ST STE 600
Second Line :
City : COSTA MESA
State : CA
Zip : 92626-1810
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 836 S MAIN ST
Second Line :
City : SALINAS
State : CA
Zip : 93901-2403
Country : US
Telephone Number : 831-305-0110
Fax Number :
Authorized Official
Title or Position : CEO
Name : GREGORY MOORE
Credential :
Telephone Number : 844-207-8321
Provider Enumeration Date : 05/19/2023
Last Update Date : 05/19/2023

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