Provider Demographics
NPI:1144221730
Name:PAULINO, JOEL JESUS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:JESUS
Last Name:PAULINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2771 SILVER CREEK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7959
Mailing Address - Country:US
Mailing Address - Phone:927-704-0222
Mailing Address - Fax:928-704-2666
Practice Address - Street 1:9505 S STEELE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-1858
Practice Address - Country:US
Practice Address - Phone:253-597-6800
Practice Address - Fax:253-597-6888
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ28843207R00000X
WAMD61251686207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z64259Medicare ID - Type Unspecified
AZH31099Medicare UPIN