Provider Demographics
NPI:1821354804
Name:PAULSEN, MARC L (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:L
Last Name:PAULSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7134 RESIDENCIA
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-9054
Mailing Address - Country:US
Mailing Address - Phone:949-612-8284
Mailing Address - Fax:
Practice Address - Street 1:7134 RESIDENCIA
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-9054
Practice Address - Country:US
Practice Address - Phone:949-612-8284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48726208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice