Provider Demographics
NPI:1700194891
Name:FLOYD, PAULETTA
Entity Type:Individual
Prefix:MRS
First Name:PAULETTA
Middle Name:
Last Name:FLOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 451925
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-8524
Mailing Address - Country:US
Mailing Address - Phone:310-714-5369
Mailing Address - Fax:
Practice Address - Street 1:1801 E 109TH PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-1215
Practice Address - Country:US
Practice Address - Phone:310-714-5369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261810743174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist