| Paul John Licata Md | |
|
25431 Cabot Rd Ste 115 Laguna Hills CA 92653-5518 | |
| (949) 448-9728 | |
| (949) 448-9732 |
| Full Name | Paul John Licata Md |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 25431 Cabot Rd, Laguna Hills, California |
| Authorized Official Name and Position | Paul John Licata (OWNER) |
| Authorized Official Contact | 9494489728 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Paul John Licata Md 25431 Cabot Rd Ste 115 Laguna Hills CA 92653-5518 Ph: (949) 448-9728 | Paul John Licata Md 25431 Cabot Rd Ste 115 Laguna Hills CA 92653-5518 Ph: (949) 448-9728 |
| NPI Number | 1356710438 |
|---|---|
| Provider Enumeration Date | 09/18/2015 |
| Last Update Date | 09/18/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356710438 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | A25662CA (California) | Primary |
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