Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY7203 | CA |
Y | 103T00000X | Psychologist | PSY7203 | CA |
NPI | 1013029354 |
---|---|
Provider Name | Paul B Gerhardt |
First Address | Redlands, CA 92373 |
Second Address | Corona, CA 92879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |