Provider Demographics
NPI:1063580587
Name:PROFFITT, PAULA A (MD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:A
Last Name:PROFFITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:550 W VISTA WY
Mailing Address - Street 2:#407
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083
Mailing Address - Country:US
Mailing Address - Phone:760-758-1092
Mailing Address - Fax:760-758-8481
Practice Address - Street 1:550 W VISTA WY
Practice Address - Street 2:#407
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083
Practice Address - Country:US
Practice Address - Phone:760-758-1092
Practice Address - Fax:760-758-8481
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG0407872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A92205Medicare UPIN