Organization
PAULUS SANTOSO MD A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAULUS LIEM SANTOSO M.D. (CEO)
(951) 530-8989
Entity
Organization
Contact information
Practice address
6969 BROCKTON AVE, SUITE A-B, RIVERSIDE, CA 92506-3809
(951) 530-8989
(951) 530-8877
Mailing address
6969 BROCKTON AVE, SUITE A-B, RIVERSIDE, CA 92506-3809
(951) 530-8989
(951) 530-8877
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
A85478
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A854780
MEDICARE
CA
05
—
00A854780
—
CA
Enumeration date
11/12/2009
Last updated
03/04/2016
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