Organization
PAUL J. LICATA MD INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL JAMES LICATA M.D. (OWNER)
(714) 827-8890
Entity
Organization
Contact information
Practice address
3356 W BALL RD, SUITE 206, ANAHEIM, CA 92804-3702
(714) 827-8890
(714) 827-8905
Mailing address
3356 W BALL RD STE 206, ANAHEIM, CA 92804-3728
(714) 827-8890
(714) 827-8905
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
A25662
CA
208D00000X
General Practice Physician
Primary
A25662
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A25662
—
CA
01
—
BS00A256626
BLUE SHIELD
—
Enumeration date
02/26/2009
Last updated
04/15/2011
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