| Organization Name: | PAULA S PRACTICE |
| NPI Number: | 1053541409 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAULA M ENYEART (C0-DIRECTOR) |
| Mailing Address: | 348 State Road 4 San Ysidro |
| State: | NM US |
| Postal Code: | 870530348 |
| Phone Number: | 5053219935 |
| Fax Number: | 5752892688 |
| NPI Enumeration Date: | 07/20/2009 |
| NPI Last Update Date: | 12/22/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | R31220 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |