Provider Demographics
NPI:1215077367
Name:GORE, PAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:GORE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8405 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3476
Mailing Address - Country:US
Mailing Address - Phone:323-330-1612
Mailing Address - Fax:323-658-6773
Practice Address - Street 1:8405 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3476
Practice Address - Country:US
Practice Address - Phone:323-330-1612
Practice Address - Fax:323-658-6773
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15275103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical