Provider Demographics
NPI:1285021741
Name:PAQUET, MARK (MBA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PAQUET
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 ARCADIA AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7223
Mailing Address - Country:US
Mailing Address - Phone:626-826-5105
Mailing Address - Fax:
Practice Address - Street 1:1680 N FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1642
Practice Address - Country:US
Practice Address - Phone:626-798-0884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA156865 IVOtherACCBC