# PAUL J. LICATA MD INC.

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

## Provider details

- **NPI number:** 1407096720
- **Authorized official:** MR. PAUL JAMES LICATA M.D. (OWNER)
- **Authorized official phone:** (714) 827-8890

## Contact information

- **Practice address:** 3356 W BALL RD, SUITE 206, ANAHEIM, CA 92804-3702
- **Practice address phone:** (714) 827-8890
- **Practice address fax:** (714) 827-8905
- **Mailing address:** 3356 W BALL RD STE 206, ANAHEIM, CA 92804-3728
- **Mailing address phone:** (714) 827-8890
- **Mailing address fax:** (714) 827-8905

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WG0000X | General Practice Registered Nurse | A25662 | CA | — |
| 208D00000X | General Practice Physician | A25662 | CA | Yes |

## Other

- **Enumeration date:** 02/26/2009
- **Last updated:** 04/15/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00A25662 | — | CA |
| 01 | — | BS00A256626 | BLUE SHIELD | — |