Healthcare Provider Details

I. General information

NPI: 1841415551
Provider Name (Legal Business Name): PAULA AYESHA HABIB M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR C/O PARADORN THIEL, UNIVERSITY OF CALIFORNIA SAN DIEGO
SAN DIEGO CA
92103-9001
US

IV. Provider business mailing address

200 WEST ARBOR DRIVE C/O PARADORN THIEL
SAN DIEGO CA
92103-8755
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-7636
  • Fax:
Mailing address:
  • Phone: 619-543-7636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35087183
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: