Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 18440 | WV |
Y | 207QA0401X | Family Doctor - Addiction Medicine | C53673 | CA |
NPI | 1144319211 |
---|---|
Provider Name | Paul M Little |
First Address | Murrieta, CA 92562-5789 |
Second Address | Murrieta, CA 92562-5789 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001713996 | BCBS (01) | WV |
3810002682 | (05) | WV |
I19021 | (02) | WV |
P00404573 | RR MEDICARE (01) | WV |