Provider Demographics
NPI:1598822801
Name:PAUL M. CHRETIEN MD INC.
Entity Type:Organization
Organization Name:PAUL M. CHRETIEN MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHRETIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-649-9800
Mailing Address - Street 1:1111 EXPOSITION BLVD
Mailing Address - Street 2:BDG 700, STE 102
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4335
Mailing Address - Country:US
Mailing Address - Phone:916-649-9800
Mailing Address - Fax:916-649-9801
Practice Address - Street 1:1111 EXPOSITION BLVD
Practice Address - Street 2:BDG 700, STE 102
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4335
Practice Address - Country:US
Practice Address - Phone:916-649-9800
Practice Address - Fax:916-649-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF09855Medicare UPIN