Healthcare Provider Details

I. General information

NPI: 1104959634
Provider Name (Legal Business Name): KARLEEN RAE PAQUETTE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 MAGNOLIA AVE
RIVERSIDE CA
92505-3043
US

IV. Provider business mailing address

410 NORTHWOOD AVE
BANNING CA
92220-5271
US

V. Phone/Fax

Practice location:
  • Phone: 951-353-4202
  • Fax:
Mailing address:
  • Phone: 626-757-4599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number22385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: