Healthcare Provider Details

I. General information

NPI: 1265632210
Provider Name (Legal Business Name): PAUL ALLEN LUOPA R.D.M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42823 WOODY KNOLL RD
MURRIETA CA
92562-3317
US

IV. Provider business mailing address

42823 WOODY KNOLL RD
MURRIETA CA
92562-3317
US

V. Phone/Fax

Practice location:
  • Phone: 951-813-9907
  • Fax:
Mailing address:
  • Phone: 951-813-9907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number104983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: