Provider Demographics
NPI:1134668791
Name:DECANO, PAULA ISABEL
Entity Type:Individual
Prefix:
First Name:PAULA ISABEL
Middle Name:
Last Name:DECANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S EL CAMINO REAL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2380
Mailing Address - Country:US
Mailing Address - Phone:650-578-8691
Mailing Address - Fax:650-393-8922
Practice Address - Street 1:2600 S EL CAMINO REAL
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2380
Practice Address - Country:US
Practice Address - Phone:650-578-8691
Practice Address - Fax:650-393-8922
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health