Provider Demographics
NPI:1922178532
Name:ALDERETE, PAUL PHILIP SR (DC IME QME)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:PHILIP
Last Name:ALDERETE
Suffix:SR
Gender:M
Credentials:DC IME QME
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 841
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90637
Mailing Address - Country:US
Mailing Address - Phone:562-921-7749
Mailing Address - Fax:562-921-0680
Practice Address - Street 1:14565 VALLEY VIEW AVE
Practice Address - Street 2:SUITE F
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670
Practice Address - Country:US
Practice Address - Phone:562-921-7749
Practice Address - Fax:562-921-0680
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT17055Medicare ID - Type Unspecified