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
1	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1144910589
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	:	13847 E 14TH ST STE 107&109
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2632
Country	:	US
Telephone Number	:	510-224-2515
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	PETER MURRAY
Credential	:
Telephone Number	:	571-224-5886

Provider Enumeration Date	:	05/09/2023
Last Update Date	:	05/05/2026

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