Healthcare Provider Details

I. General information

NPI: 1144319211
Provider Name (Legal Business Name): PAUL M LITTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40700 CALIFORNIA OAKS RD STE 202
MURRIETA CA
92562-5789
US

IV. Provider business mailing address

40700 CALIFORNIA OAKS RD STE 202
MURRIETA CA
92562-5789
US

V. Phone/Fax

Practice location:
  • Phone: 951-894-5072
  • Fax:
Mailing address:
  • Phone: 951-894-5072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18440
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberC53673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: