Basic Information
| Provider Information | |||||||||
| NPI: | 1447351085 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AGNIHOTRI | ||||||||
| FirstName: | PARAG | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 232410 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921932410 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 W ARBOR DR | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009268273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 11/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C52218 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | C52218 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000810783729 | 01 | CA | PHCS | OTHER | 00C522180 | 01 | CA | BLUE SHIELD | OTHER | 90204087 | 01 | CA | PACIFICARE | OTHER | G33106 | 01 | CA | BLUE CROSS | OTHER | MCMG465400 | 01 | CA | WESTERN HEALTH ADVANTAGE | OTHER | 1907932 | 01 | CA | CIGNA | OTHER | 5466247 | 01 | CA | FIRST HEALTH | OTHER | 131552 | 01 | CA | HEALTH NET | OTHER | 2049274 | 01 | CA | GREAT WEST | OTHER | 311160 | 01 | CA | INTERPLAN | OTHER | 7228180 | 01 | CA | AETNA | OTHER |