Healthcare Provider Details

I. General information

NPI: 1982764858
Provider Name (Legal Business Name): PAULINA JOSE AVENDANO MD,FAAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 AVENIDA VISTA HERMOSA SUITE 250
SAN CLEMENTE CA
92673
US

IV. Provider business mailing address

638 CAMINO DE LOS MARES H130-403
SAN CLEMENTE CA
92673
US

V. Phone/Fax

Practice location:
  • Phone: 949-429-7700
  • Fax: 949-429-7704
Mailing address:
  • Phone: 949-682-5738
  • Fax: 949-326-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG077201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: