Provider Demographics
NPI:1003067901
Name:PAULA, JOERG (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOERG
Middle Name:
Last Name:PAULA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:HANA
Mailing Address - State:HI
Mailing Address - Zip Code:96713-0364
Mailing Address - Country:US
Mailing Address - Phone:808-344-2785
Mailing Address - Fax:808-248-7228
Practice Address - Street 1:27 ALAU STREET
Practice Address - Street 2:
Practice Address - City:HANA
Practice Address - State:HI
Practice Address - Zip Code:96713
Practice Address - Country:US
Practice Address - Phone:808-344-2785
Practice Address - Fax:808-248-7228
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3013174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist