Provider Demographics
NPI:1215828462
Name:KISS, PAULA
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:KISS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 12TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0834
Mailing Address - Country:US
Mailing Address - Phone:209-412-3035
Mailing Address - Fax:
Practice Address - Street 1:1130 12TH ST STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0834
Practice Address - Country:US
Practice Address - Phone:209-525-6043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist