Provider Demographics
NPI:1134456510
Name:JUSTIN PAQUETTE MD CORPORATION
Entity type:Organization
Organization Name:JUSTIN PAQUETTE MD CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:PAQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MA
Authorized Official - Phone:916-341-0310
Mailing Address - Street 1:3800 J ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5551
Mailing Address - Country:US
Mailing Address - Phone:916-341-0310
Mailing Address - Fax:916-341-0340
Practice Address - Street 1:3800 J ST STE 210
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5551
Practice Address - Country:US
Practice Address - Phone:916-341-0310
Practice Address - Fax:916-341-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91868207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty