Healthcare Provider Details

I. General information

NPI: 1497895775
Provider Name (Legal Business Name): DONALD SCOTT PAULSEN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SYLVAN AVE STE A
MODESTO CA
95350-1699
US

IV. Provider business mailing address

3204 WYCLIFFE DR
MODESTO CA
95355-4738
US

V. Phone/Fax

Practice location:
  • Phone: 209-422-6120
  • Fax:
Mailing address:
  • Phone: 209-402-4537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number16036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: