Provider Demographics
NPI:1366635658
Name:SHORE, PAULA B (DO)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:B
Last Name:SHORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 PARK DR
Mailing Address - Street 2:APT C
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-4248
Mailing Address - Country:US
Mailing Address - Phone:760-476-2953
Mailing Address - Fax:
Practice Address - Street 1:6260 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-1609
Practice Address - Country:US
Practice Address - Phone:760-476-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A7172OtherLICENSE NUMBER