Provider Demographics
NPI:1134157712
Name:PAOLI, FREDERICK MARK (AT,C , PTA)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:MARK
Last Name:PAOLI
Suffix:
Gender:M
Credentials:AT,C , PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27992 VIA DEL AGUA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7358
Mailing Address - Country:US
Mailing Address - Phone:949-716-0332
Mailing Address - Fax:949-716-9317
Practice Address - Street 1:27992 VIA DEL AGUA
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7358
Practice Address - Country:US
Practice Address - Phone:949-716-0332
Practice Address - Fax:949-716-9317
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT4149247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other