Provider Demographics
NPI:1932509593
Name:ARCHIBEQUE, PAUL M
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:ARCHIBEQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S MANCHESTER AVE
Mailing Address - Street 2:315 - UCI-UPS PROVIDER RELATIONS
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3217
Mailing Address - Country:US
Mailing Address - Phone:714-456-2986
Mailing Address - Fax:714-456-2979
Practice Address - Street 1:2500 RED HILL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5518
Practice Address - Country:US
Practice Address - Phone:949-267-0400
Practice Address - Fax:949-221-0004
Is Sole Proprietor?:No
Enumeration Date:2014-09-01
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
1-21-49249103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor