Basic Information
| Provider Information | |||||||||
| NPI: | 1710225842 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WAY | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3480 BUSKIRK AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945234343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9258254700 | ||||||||
| FaxNumber: | 9258252610 | ||||||||
| Practice Location | |||||||||
| Address1: | 3480 BUSKIRK AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945234343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9258254700 | ||||||||
| FaxNumber: | 9258252610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2013 | ||||||||
| LastUpdateDate: | 01/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | 36027 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.