Provider Demographics
NPI:1114064714
Name:PARAG MEDICAL, INC
Entity Type:Organization
Organization Name:PARAG MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:PARAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-661-2455
Mailing Address - Street 1:657 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 243
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2811
Mailing Address - Country:US
Mailing Address - Phone:949-661-2455
Mailing Address - Fax:949-661-5751
Practice Address - Street 1:657 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 243
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2811
Practice Address - Country:US
Practice Address - Phone:949-661-2455
Practice Address - Fax:949-661-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97392208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0105260Medicaid