PAUL J. LICATA MD INC. (NPI# 1407096720) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407096720 |
| Entity Type | Organization |
| Organization Name | PAUL J. LICATA MD INC. |
| Practice Address |
3356 W Ball Rd Suite 206 Anaheim CA 92804-3702 |
| Mailing Address |
3356 W Ball Rd Ste 206 Anaheim CA 92804-3728 |
| Practice Telephone | 7148278890 |
| Practice Fax Number | 7148278905 |
| Mailing Telephone | 7148278890 |
| Mailing Fax Number | 7148278905 |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2011-04-15 |
| Authorized Official Name | MR. PAUL JAMES LICATA (OWNER) |
| Authorized Official Telephone | 7148278890 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WG0000X |
Registered Nurse Specialization: General Practice |
A25662 | CA | Nursing Service Providers |
| Y | 208D00000X | General Practice | A25662 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00A25662 | 05 | |
| BLUE SHIELD | BS00A256626 | 01 |
| Street Address |
3356 W BALL RD SUITE 206 |
| City | ANAHEIM |
| State | CA |
| Zip Code | 92804-3702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922060086 | Omar Othman Fadeel | Internal Medicine | 3356 W Ball Rd, Suite# 100, Anaheim, CA 92804-3702 | 2006-04-04 |
| 1740534932 | Omar O. Fadeel, Md | Non-Pharmacy Dispensing Site | 3356 W Ball Rd, 100, Anaheim, CA 92804-3702 | 2012-11-09 |
| 1467741983 | David S Kramer Md A Professional Corporation | Internal Medicine | 3356 W Ball Rd, 206, Anaheim, CA 92804-3702 | 2011-04-05 |
| 1386933349 | Anaheim-buena Park Regional Dialysis Center | Clinic/Center | 3356 W Ball Rd, Suite 110, Anaheim, CA 92804-3702 | 2011-03-30 |
| 1770758310 | Sheldon Fayner | Family Medicine | 3356 W Ball Rd, Ste 206, Anaheim, CA 92804-3702 | 2008-04-24 |
| 1306011150 | David S Kramer Md A Professional Corporation | Internal Medicine | 3356 W Ball Rd, Suite 206, Anaheim, CA 92804-3702 | 2008-04-23 |
| 1811181845 | Anthony Wong,d.d.s. | Clinic/Center | 3356 W Ball Rd, Ste.215, Anaheim, CA 92804-3702 | 2007-09-04 |
| 1013121292 | Flora Y Chen Dds, Inc | Dentist | 3356 W Ball Rd, Suite 118, Anaheim, CA 92804-3702 | 2007-05-09 |
| 1003948035 | Bakthan Savarirayan | Surgery | 3356 W Ball Rd, Suite 205, Anaheim, CA 92804-3702 | 2007-03-13 |
| 1205970407 | Prestige Hospice Care, Inc. | Hospice Care, Community Based | 3356 W Ball Rd, Suite 216, Anaheim, CA 92804-3702 | 2007-02-19 |
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| 1154971646 | Leita Pawline Lawrene | Technician | 900 S Beach Blvd # 132, Anaheim, CA 92804 | 2019-09-17 |
| 1942767611 | Yasmen Abuyousef | Behavior Technician | 714 W Commonweath Ave, Suite C, Fullerton, CA 92804 | 2019-02-28 |
| 1225501224 | Brandon Pourazima | Physician Assistant | 631 S Brookhurst St Ste 213b, Anaheim, CA 92804 | 2019-01-02 |
| 1043782576 | Origins Home Health Care Inc. | Home Health | 137 1/2 S So Knott, Anaheim, CA 92804 | 2018-12-21 |
| 1346762150 | Inhee Shinn | Acupuncturist | 1717 W. Ball Road., Anaheim, CA 92804 | 2017-07-13 |
| 1689122459 | Jayanthi Ravikumar Md Inc | Physical Medicine & Rehabilitation | 3356 W Ball Road, #216, Anaheim, CA 92804 | 2016-09-21 |
| 1215307954 | Tuan Manh Hoang | Dentist | 1317 S. Courtright Street, Anaheim, CA 92804 | 2015-10-06 |
| 1598101602 | Optimal Sleep Center | Clinical Medical Laboratory | 3340 West Ball Road Suite B, Anaheim, CA 92804 | 2013-05-15 |
| 1376885673 | Michelle Lananh Dang | Pharmacist | 1913 W. Elm Pl, Anaheim, CA 92804 | 2013-03-25 |
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| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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|---|---|---|---|---|
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| 1316257900 | George Youssef, M.d., A Medical Corporation | General Practice | 1120 W La Palma Ave Ste 10, Anaheim, CA 92801-2805 | 2010-10-15 |
| 1366672099 | Mpn, Medical Providers Group, Inc. | General Practice | 1811 E Center St, 210, Anaheim, CA 92805-3401 | 2009-07-15 |
| 1134362346 | Sea Stars Wellness Center | General Practice | 1775 E Lincoln Ave Ste 101, Anaheim, CA 92805-4300 | 2009-04-17 |
| 1194965798 | Pramar Medical Clinic Inc. | General Practice | 1775 E Lincoln Ave, Anaheim, CA 92805-4366 | 2009-02-23 |
| 1710156245 | Hung Tran | General Practice | 6017 E La Paz Cir, Anaheim, CA 92807-3926 | 2008-02-28 |
| 1194934711 | Humberto Agustin Florian | General Practice | 2090 S Euclid St, Suite 104, Anaheim, CA 92802-3143 | 2007-05-21 |
| 1285788059 | Central City Community Health Center, Inc. | General Practice | 2237 W Ball Rd, Anaheim, CA 92804 | 2007-01-22 |
| 1932281573 | Adela P Pena | General Practice | 50 S Anaheim Blvd, #96, Anaheim, CA 92805 | 2006-10-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.