Provider Demographics
NPI:1417951310
Name:PYKA, PAUL ARTHUR (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ARTHUR
Last Name:PYKA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 CENTER DR
Mailing Address - Street 2:STE 100
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3099
Mailing Address - Country:US
Mailing Address - Phone:619-463-9195
Mailing Address - Fax:619-463-0956
Practice Address - Street 1:8851 CENTER DR
Practice Address - Street 2:STE 100
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3099
Practice Address - Country:US
Practice Address - Phone:619-463-9195
Practice Address - Fax:619-463-0956
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A44620207V00000X, 207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX44620Medicaid
A93582Medicare UPIN
20A4462Medicare ID - Type Unspecified