Provider Demographics
NPI:1902177470
Name:AG PAIN MANAGEMENT INC
Entity Type:Organization
Organization Name:AG PAIN MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:619-227-2353
Mailing Address - Street 1:1687 ERRINGER ROAD
Mailing Address - Street 2:# 217
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065
Mailing Address - Country:US
Mailing Address - Phone:805-526-1700
Mailing Address - Fax:805-512-7880
Practice Address - Street 1:1687 ERRINGER ROAD
Practice Address - Street 2:# 217
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:805-526-1700
Practice Address - Fax:805-512-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-16
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11210207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A11210OtherMEDICAL LICENSE #
CADM6562Medicare PIN
CA20A11210OtherMEDICAL LICENSE #
FW711AMedicare PIN