institution
Paul J. Licata Md Inc.
General Practice Physician in Anaheim, California
NPI 1407096720

Paul J. Licata Md Inc. is a General Practice Physician based in Anaheim, CA. Paul J. Licata Md Inc. practices in Anaheim, CA. The NPI Number for Paul J. Licata Md Inc. is 1407096720 and holds a License No. A25662 (California).

The current practice location address for Paul J. Licata Md Inc. is 3356 W Ball Rd, Anaheim, CA and can be reached out via phone at 714-827-8890 and via fax at 714-827-8905.

Location: 3356 W Ball Rd, Anaheim, CA, 92804-3728
institution
Provider Profile Details
NPI Number
1407096720
Provider Name
Paul J. Licata Md Inc.
Credential
Provider Entity Type
Organization
Address
3356 W Ball Rd, Anaheim, CA, 92804-3728
Phone Number
714-827-8890
Fax Number
714-827-8905
Provider Enumeration Date
02/26/2009
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
BS00A256626 01 BLUE SHIELD
00A25662 05 CA
institution
Provider Business Practice Location Address Details
Address
3356 W Ball Rd
City
State
Zip
92804-3702
Phone Number
714-827-8890
Fax Number
714-827-8905
person
Provider Business Mailing Address Details
Address
3356 W Ball Rd
City
State
Zip
92804-3702
Phone Number
714-827-8890
Fax Number
714-827-8905
person
Provider's Taxonomy Details 1
Type
Nursing Service Providers
Classification
Registered Nurse
Speciality
General Practice
Taxonomy
License No.
A25662 (California)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
License No.
A25662 (California)
Definition
Definition to come...
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