Healthcare Provider Details

I. General information

NPI: 1992830426
Provider Name (Legal Business Name): HENRY PAUL HOWARD LPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 E MOUNTAIN VIEW ST
BARSTOW CA
92311-3033
US

IV. Provider business mailing address

805 E MOUNTAIN VIEW ST
BARSTOW CA
92311-3033
US

V. Phone/Fax

Practice location:
  • Phone: 760-256-5026
  • Fax: 760-256-5092
Mailing address:
  • Phone: 760-256-5026
  • Fax: 760-256-5092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number23912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: