Provider Demographics
NPI:1447351085
Name:AGNIHOTRI, PARAG (MD)
Entity type:Individual
Prefix:
First Name:PARAG
Middle Name:
Last Name:AGNIHOTRI
Suffix:
Gender:
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:FILE 57326
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-7326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:800-926-8273
Practice Address - Fax:888-539-8781
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52218207RG0300X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000810783729OtherPHCS
CA00C522180OtherBLUE SHIELD
CA90204087OtherPACIFICARE
CAG33106OtherBLUE CROSS
CAMCMG465400OtherWESTERN HEALTH ADVANTAGE
CA1907932OtherCIGNA
CA5466247OtherFIRST HEALTH
CA131552OtherHEALTH NET
CA2049274OtherGREAT WEST
CA311160OtherINTERPLAN
CA7228180OtherAETNA
CA2049274OtherGREAT WEST
CAMCMG465400OtherWESTERN HEALTH ADVANTAGE