MEDICARE: MR. RICHARD PAULEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1699521427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD PAULEY

Provider Business Mailing Address
First Line	:	5021 ATLANTIC AVE APT 56
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-6576
Country	:	US
Telephone Number	:	951-324-3725
Fax Number	:

Provider Business Practice Location Address
First Line	:	5021 ATLANTIC AVE APT 56
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-6576
Country	:	US
Telephone Number	:	951-324-3725
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2024
Last Update Date	:	04/24/2024

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