Provider Demographics
NPI:1659399632
Name:CUSTER, PAUL J (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:CUSTER
Suffix:
Gender:M
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:VA LOMA LINDA HEALTHCARE SYSTEM # 116A
Mailing Address - Street 2:11201 BENTON STREET
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92357-0001
Mailing Address - Country:US
Mailing Address - Phone:909-946-2594
Mailing Address - Fax:909-777-3226
Practice Address - Street 1:VA LOMA LINDA HEALTHCARE SYSTEM # 116A
Practice Address - Street 2:11201 BENTON STREET
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-0001
Practice Address - Country:US
Practice Address - Phone:909-946-2594
Practice Address - Fax:909-777-3226
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY18424103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic