MEDICARE: DR. PETRA PAULE M.D.

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	207Q00000X	Family Medicine Physician	G78702	CA

General Provider Information

NPI Number	:	1922158468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETRA PAULE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 8204
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92658-8204
Country	:	US
Telephone Number	:	949-760-9181
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 BRISTOL ST N
Second Line	:	SUITE #1B
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-8916
Country	:	US
Telephone Number	:	949-752-6300
Fax Number	:

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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