Provider Demographics
NPI:1467180331
Name:VAALA, PAUL THOMAS II
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:VAALA
Suffix:II
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 1:615 W CIVIC CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4052
Mailing Address - Country:US
Mailing Address - Phone:714-795-3444
Mailing Address - Fax:714-795-3445
Practice Address - Street 1:615 W CIVIC CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4052
Practice Address - Country:US
Practice Address - Phone:714-795-3444
Practice Address - Fax:714-795-3445
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14668101YA0400X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)