Provider Demographics
NPI:1013029354
Name:GERHARDT, PAUL B (PHD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:B
Last Name:GERHARDT
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 1:101 E REDLANDS BLVD
Mailing Address - Street 2:SUITE 234
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373
Mailing Address - Country:US
Mailing Address - Phone:909-335-3026
Mailing Address - Fax:909-335-3167
Practice Address - Street 1:707 MAGNOLIA AVE SUITE 1F
Practice Address - Street 2:INLAND PSYCHIATRIC MEDICAL GROUP INC
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879
Practice Address - Country:US
Practice Address - Phone:951-737-1917
Practice Address - Fax:951-735-4105
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7203103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist