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General NPI Number Information
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NPI Number | 1407096720
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Entity Type | Organization
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Legal Business Name | PAUL J. LICATA MD INC.
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 04/15/2011
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Provider Practice Location Address
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Address Line | 3356 W BALL RD SUITE 206
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City | ANAHEIM
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State | CA
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Zip | 92804-3702
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Country | US
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Telephone | 714-827-8890
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Fax | 714-827-8905
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Provider Business Mailing Address
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Address Line | 3356 W BALL RD STE 206
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City | ANAHEIM
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State | CA
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Zip | 92804-3728
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Country | US
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Telephone | 714-827-8890
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Fax | 714-827-8905
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Authorized Official
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Title or Position | OWNER
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Name | MR. PAUL JAMES LICATA
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Credential | M.D.
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Telephone | 714-827-8890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | A25662
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A25662
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License Number State | CA
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