Provider Demographics
NPI:1922185560
Name:GASTON, PATRICIA SUE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:SUE
Last Name:GASTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33912 MALAGA DR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2455
Mailing Address - Country:US
Mailing Address - Phone:949-496-2931
Mailing Address - Fax:949-296-2931
Practice Address - Street 1:26891 SPRING ST
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2692
Practice Address - Country:US
Practice Address - Phone:949-496-2931
Practice Address - Fax:949-496-1165
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15968103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist