Provider Demographics
NPI:1093195661
Name:PAUL OBERON, PSY.D., INC.
Entity Type:Organization
Organization Name:PAUL OBERON, PSY.D., INC.
Other - Org Name:PAUL OBERON, PSY.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:323-937-7777
Mailing Address - Street 1:7421 BEVERLY BLVD
Mailing Address - Street 2:#10
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2703
Mailing Address - Country:US
Mailing Address - Phone:323-937-7777
Mailing Address - Fax:323-937-2222
Practice Address - Street 1:7421 BEVERLY BLVD
Practice Address - Street 2:#10
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-2703
Practice Address - Country:US
Practice Address - Phone:323-937-7777
Practice Address - Fax:323-937-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14806103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP14806Medicare PIN