Provider Demographics
NPI:1861687816
Name:YABLO, PAUL DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:YABLO
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 1:474 55TH ST
Mailing Address - Street 2:APT. C
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1937
Mailing Address - Country:US
Mailing Address - Phone:510-653-4141
Mailing Address - Fax:510-653-4141
Practice Address - Street 1:2258 SANTA CLARA AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4498
Practice Address - Country:US
Practice Address - Phone:510-337-9408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12488103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical