Provider Demographics
NPI:1235157363
Name:URREA, PAUL T (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:T
Last Name:URREA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25050 AVENUE KEARNY STE 208
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1257
Mailing Address - Country:US
Mailing Address - Phone:661-430-0935
Mailing Address - Fax:661-295-0862
Practice Address - Street 1:4560 E CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1168
Practice Address - Country:US
Practice Address - Phone:323-980-9900
Practice Address - Fax:626-289-4242
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG51075207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01560ZOtherBLUE SHIELD ID#
CA0791060001OtherDMERC ID#
CA00G510750Medicaid
CAWG51075BMedicare ID - Type UnspecifiedMEDICARE RENDERING#
CAA51891Medicare UPIN
CAZZZ01560ZOtherBLUE SHIELD ID#