Healthcare Provider Details

I. General information

NPI: 1063106516
Provider Name (Legal Business Name): PAULMO ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BLACKSTONE VALLEY PL BLDG 7
LINCOLN RI
02865-1179
US

IV. Provider business mailing address

331 JASTRAM ST
PROVIDENCE RI
02908-2119
US

V. Phone/Fax

Practice location:
  • Phone: 504-234-7369
  • Fax:
Mailing address:
  • Phone: 504-234-7369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL MORETTI JR.
Title or Position: CEO/OWNER
Credential:
Phone: 504-234-7369