# PAULUS SANTOSO MD A PROFESSIONAL CORPORATION

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093042970
- **Authorized official:** DR. PAULUS LIEM SANTOSO M.D. (CEO)
- **Authorized official phone:** (951) 530-8989

## Contact information

- **Practice address:** 6969 BROCKTON AVE, SUITE A-B, RIVERSIDE, CA 92506-3809
- **Practice address phone:** (951) 530-8989
- **Practice address fax:** (951) 530-8877
- **Mailing address:** 6969 BROCKTON AVE, SUITE A-B, RIVERSIDE, CA 92506-3809
- **Mailing address phone:** (951) 530-8989
- **Mailing address fax:** (951) 530-8877

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207VX0000X | Obstetrics Physician | A85478 | CA | Yes |

## Other

- **Enumeration date:** 11/12/2009
- **Last updated:** 03/04/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00A854780 | MEDICARE | CA |
| 05 | — | 00A854780 | — | CA |