Healthcare Provider Details

I. General information

NPI: 1245870740
Provider Name (Legal Business Name): PAUL SINGH JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 PENNSYLVANIA AVE
FAIR OAKS CA
95628-7413
US

IV. Provider business mailing address

4112 PENNSYLVANIA AVE
FAIR OAKS CA
95628-7413
US

V. Phone/Fax

Practice location:
  • Phone: 916-619-7744
  • Fax:
Mailing address:
  • Phone: 916-619-7744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number130110
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: