Organization · NPI-2

Paul J. Licata MD INC.

General Practice · Anaheim, CA

NPI number1407096720
StatusActive
Last updated in NPPESApr 15, 2011

Details

NPI
1407096720
Entity type
Organization (NPI-2)
Legal business name
Paul J. Licata MD INC.
Organization subpart
No
Enumeration date
Feb 26, 2009
Last updated
Apr 15, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208D00000X General PracticeA25662CAYes
163WG0000X Registered Nurse, General PracticeA25662CA

Practice location

3356 W Ball Rd
Suite 206
Anaheim, CA 92804-3702

Phone 714-827-8890 · Fax 714-827-8905

Mailing address

3356 W Ball Rd Ste 206
Anaheim, CA 92804-3728

Phone 714-827-8890 · Fax 714-827-8905

Authorized official

Paul James Licata
Owner
7148278890

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