Provider Demographics
NPI:1922158468
Name:PAULE, PETRA (MD)
Entity Type:Individual
Prefix:DR
First Name:PETRA
Middle Name:
Last Name:PAULE
Suffix:
Gender:F
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:PO BOX 8204
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-8204
Mailing Address - Country:US
Mailing Address - Phone:949-760-9181
Mailing Address - Fax:
Practice Address - Street 1:1000 BRISTOL ST N
Practice Address - Street 2:SUITE #1B
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8916
Practice Address - Country:US
Practice Address - Phone:949-752-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine