Provider Demographics
NPI:1417097098
Name:PARAG, AMIT (MD)
Entity Type:Individual
Prefix:MR
First Name:AMIT
Middle Name:
Last Name:PARAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:92673-2826
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:92673-2826
Practice Address - Country:US
Practice Address - Phone:949-661-2455
Practice Address - Fax:949-661-5751
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA97392208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics