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NPI Code Detail

MEDICARE: MARK PAQUET MBA

MEDICARE: MARK PAQUET MBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1156865 IVOTHERCAACCBC

General Provider Information

NPI Number : 1285021741
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK PAQUET MBA
Provider Business Mailing Address
First Line : 824 ARCADIA AVE APT 8
Second Line :
City : ARCADIA
State : CA
Zip : 91007-7223
Country : US
Telephone Number : 626-826-5105
Fax Number :
Provider Business Practice Location Address
First Line : 1680 N FAIR OAKS AVE
Second Line :
City : PASADENA
State : CA
Zip : 91103-1642
Country : US
Telephone Number : 626-798-0884
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2015
Last Update Date : 11/23/2015

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Directions to “ MARK PAQUET MBA” Practice Location

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