Basic Information
Provider Information | |||||||||
NPI: | 1245399641 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SILVERMAN | ||||||||
FirstName: | PAUL | ||||||||
MiddleName: | D | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 800 S VICTORIA AVE, L4615 | ||||||||
Address2: | VCHCA - PHYSICIAN SERVICES | ||||||||
City: | VENTURA | ||||||||
State: | CA | ||||||||
PostalCode: | 930090003 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8056775181 | ||||||||
FaxNumber: | 8056775304 | ||||||||
Practice Location | |||||||||
Address1: | 145 N BRENT ST | ||||||||
Address2: | SUITE 202 | ||||||||
City: | VENTURA | ||||||||
State: | CA | ||||||||
PostalCode: | 93003 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8056434067 | ||||||||
FaxNumber: | 8056434587 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/08/2006 | ||||||||
LastUpdateDate: | 12/02/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | C40063 | CA | Y |   | Allopathic & Osteopathic Physicians | Urology |   |
ID Information
ID | Type | State | Issuer | Description | 00C400630 | 05 | CA |   | MEDICAID |