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General NPI Number Information
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NPI Number | 1700194891
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Entity Type | Individual
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Provider Name | MRS. PAULETTA FLOYD
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Gender | Female
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 1801 E 109TH PL
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City | LOS ANGELES
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State | CA
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Zip | 90059-1215
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Country | US
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Telephone | 310-714-5369
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 451925
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City | LOS ANGELES
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State | CA
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Zip | 90045-8524
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Country | US
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Telephone | 310-714-5369
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 261810743
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License Number State | CA
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