Basic Information
| Provider Information | |||||||||
| NPI: | 1457483141 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUVICK | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1559 | ||||||||
| Address2: | ATTENTION ANN LEE CLINICS SIERRA VISTA | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933021559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6616353050 | ||||||||
| FaxNumber: | 6618691503 | ||||||||
| Practice Location | |||||||||
| Address1: | 7839 BURGANDY AVE | ||||||||
| Address2: | |||||||||
| City: | LAMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618455100 | ||||||||
| FaxNumber: | 6618455166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| 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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.