Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Individual
PAUL FILE
Active
Individual
PAUL FILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A61291
CA
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
A61291
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A612910
BLUE SHIELD
CA
01
—
930086626
RAILROAD
CA
Enumeration date
08/23/2006
Last updated
03/21/2023
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