Provider Demographics
NPI:1508902487
Name:PAOLETTI, ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:PAOLETTI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4477 W. 118TH ST., STE 105
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250
Mailing Address - Country:US
Mailing Address - Phone:310-679-2251
Mailing Address - Fax:310-679-9387
Practice Address - Street 1:4477 W. 118TH ST., STE 105
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250
Practice Address - Country:US
Practice Address - Phone:310-679-2251
Practice Address - Fax:310-679-9387
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3861213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3861OtherLIC
CA000E38612Medicaid
CA000E38612Medicaid
CAU38158Medicare UPIN