Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1013028265 |
---|---|
Provider Name | Dr. Paul T Depompo |
First Address | Newport Beach, CA 92660-3500 |
Second Address | Newport Beach, CA 92660-2217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 06/05/2009 |