Basic Information
| Provider Information | |||||||||
| NPI: | 1033103619 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAUCK | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5070 ADALIS DR | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957586778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163929970 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 60MDG/SGOHH | ||||||||
| Address2: | 101 BODIN CIR | ||||||||
| City: | TRAVIS AFB | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074235174 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | 6689 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No ID Information.