Provider Demographics
NPI:1568420776
Name:PAULIN, ANDREW (ATC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:PAULIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20617 DELORAINE DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2521
Mailing Address - Country:US
Mailing Address - Phone:909-594-5611
Mailing Address - Fax:909-869-1076
Practice Address - Street 1:1100 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1341
Practice Address - Country:US
Practice Address - Phone:909-594-5611
Practice Address - Fax:909-869-1076
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer