Provider Demographics
NPI:1033781141
Name:PAUL, ARUP
Entity Type:Individual
Prefix:
First Name:ARUP
Middle Name:
Last Name:PAUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 S VICTORIA AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-2145
Mailing Address - Country:US
Mailing Address - Phone:951-530-2965
Mailing Address - Fax:
Practice Address - Street 1:28078 BAXTER RD STE 530
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-1405
Practice Address - Country:US
Practice Address - Phone:951-566-5229
Practice Address - Fax:951-698-0272
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPA60450363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program