Provider Demographics
NPI:1649318338
Name:OSTOYA, PAUL WITOLD (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WITOLD
Last Name:OSTOYA
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 1:1095 E WARNER AVE
Mailing Address - Street 2:#101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-4000
Mailing Address - Country:US
Mailing Address - Phone:559-435-3567
Mailing Address - Fax:
Practice Address - Street 1:1095 E WARNER AVE
Practice Address - Street 2:#101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-4000
Practice Address - Country:US
Practice Address - Phone:559-435-3567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52252207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A522521Medicaid
CA00A522520Medicare ID - Type UnspecifiedMEDICARE
CA00A522521Medicaid