Provider Demographics
NPI:1477760098
Name:DORES, PAUL ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALAN
Last Name:DORES
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:PO BOX 500602
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-0602
Mailing Address - Country:US
Mailing Address - Phone:619-884-1407
Mailing Address - Fax:858-679-6610
Practice Address - Street 1:13135 OLD SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4041
Practice Address - Country:US
Practice Address - Phone:619-884-1407
Practice Address - Fax:858-679-6610
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11406103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist