Paul John Licata, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A25662 Issued in CA

Practice address

1717 E Lincoln Ave
Anaheim, CA 92805-4345

Phone

(714) 635-2642

Fax

(714) 635-8547

NPI assigned

Oct 18, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Paul John Licata MD

  • Primary Care Clinic/Center
  • Laguna Hills, CA
  • NPI 1356710438
  NPD (past) Authorized official
• Joanne G Pagal DO Inc.

  • Family Medicine Physician
  • Laguna Hills, CA
  • NPI 1073682225
  NPD (past)

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1740361518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16702 VALLEY VIEW AVE",
            "city": "LA MIRADA",
            "state": "CA",
            "postal_code": "906385824",
            "telephone_number": "714-367-5360",
            "fax_number": "714-635-5428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 E LINCOLN AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928054345",
            "telephone_number": "714-635-2642",
            "fax_number": "714-635-8547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICATA",
        "first_name": "PAUL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A25662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Libby, MD
• Liberty House
• Liberty House
• Jimmy P Liboon, PA
• Christian M Libutti, PHD
• Devina Licerio
• Bianca Licon
• Sara Licon, LCSW
• Michelle Liem, D.D.S.
• Bryan Shawn Lien

• Family Medicine Physician in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.