Individual
THEODORA GORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTIONER
Contact information
Practice address
4650 W SUNSET BLVD # 53, LOS ANGELES, CA 90027-6062
(323) 361-7730
Mailing address
1814 ARMOUR LANE, REDONDO BEACH, CA 90278
(310) 379-2106
(310) 680-9350
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN522355
CA
363LW0102X
Women's Health Nurse Practitioner
RN522355
CA
Other
Enumeration date
04/11/2007
Last updated
10/11/2017
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