Provider Demographics
NPI:1609848076
Name:PAULSON, ERIC PUCCINI (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:PUCCINI
Last Name:PAULSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10158 MONACO DR
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-2322
Mailing Address - Country:US
Mailing Address - Phone:909-758-0805
Mailing Address - Fax:909-427-7601
Practice Address - Street 1:9985 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:909-427-7087
Practice Address - Fax:909-427-7601
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35464207Y00000X
CAA95370207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI03181Medicare UPIN