Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY 12618 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 12618 | CA |
NPI | 1003265547 |
---|---|
Provider Name | Dr. Paul Fick |
First Address | Laguna Niguel, CA 92677-1483 |
Second Address | Laguna Niguel, CA 92677-1483 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2016 |
Last Update Date | 06/06/2016 |