Paul J. Licata MD Inc.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A25662 Issued in CA

Legal business name

PAUL J. LICATA MD INC.

Practice address

3356 W Ball Rd
Suite 206
Anaheim, CA 92804-3702

Phone

(714) 827-8890

Fax

(714) 827-8905

NPI assigned

Feb 26, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Paul James Licata, M.D.

Title

Owner

Phone

(714) 827-8890

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302825600000",
    "number": "1407096720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3356 W BALL RD STE 206",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928043728",
            "telephone_number": "714-827-8890",
            "fax_number": "714-827-8905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3356 W BALL RD",
            "address_2": "SUITE 206",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928043702",
            "telephone_number": "714-827-8890",
            "fax_number": "714-827-8905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL J. LICATA MD INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-26",
        "last_updated": "2011-04-15",
        "status": "A",
        "authorized_official_last_name": "LICATA",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-827-8890",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse, General Practice",
            "state": "CA",
            "license": "A25662",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A25662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "BS00A256626",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A25662",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria Juliet Migliorini Pattison, MA, ATC
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• Larissa Patton
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• Paul E Villarubia DDS Inc
• Paul Kim MD Inc.
• Dayna Paul
• Daniel Paulin, BS
• Edna Nohemi Paulin
• Magdalena Paulin

• General Practice Physician in Anaheim, CA
• Providers in Anaheim, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.