Provider Demographics
NPI:1417342981
Name:AGARWAL, DEEPAK (DO MPH)
Entity Type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:DO MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10989 BLUFFSIDE DR APT 3106
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-4406
Mailing Address - Country:US
Mailing Address - Phone:614-634-6377
Mailing Address - Fax:
Practice Address - Street 1:222 W PUEBLO ST STE B
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3805
Practice Address - Country:US
Practice Address - Phone:805-563-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A19239207L00000X
390200000X
CA20A18239207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program