Provider Demographics
NPI:1932159274
Name:GASPAR, PAUL DAVID (DPT)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:GASPAR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7760 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8553
Mailing Address - Country:US
Mailing Address - Phone:760-634-9750
Mailing Address - Fax:760-634-9752
Practice Address - Street 1:7760 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8553
Practice Address - Country:US
Practice Address - Phone:760-634-9750
Practice Address - Fax:760-634-9752
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19567174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT19567OtherPT LICENSE #
CAPT19567OtherPT LICENSE #
CAWPT19567AMedicare ID - Type Unspecified
CAW19567BMedicare ID - Type Unspecified