Provider Demographics
NPI:1972615227
Name:CHRETIEN, PAUL MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:CHRETIEN
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 1:1111 EXPOSITION BLVD., BLDG 700, STE 102
Mailing Address - Street 2:
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., BLDG 700, STE 102
Practice Address - Street 2:
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0416492080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A41649Medicaid
CA00A41649Medicaid