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General NPI Number Information
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NPI Number | 1770607947
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Entity Type | Organization
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Legal Business Name | PAUL J PERCIVAL M D MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 591 MCCRAY ST SUITE 221
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City | HOLLISTER
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State | CA
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Zip | 95023-2224
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Country | US
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Telephone | 831-638-9715
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Fax | 831-637-7691
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Provider Business Mailing Address
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Address Line | 591 MCCRAY ST SUITE 221
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City | HOLLISTER
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State | CA
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Zip | 95023-2224
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Country | US
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Telephone | 831-638-9715
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Fax | 831-637-7691
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KRISTEN VALLEJO
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Credential |
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Telephone | 831-638-9715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G83115
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License Number State | CA
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