Healthcare Provider Details

I. General information

NPI: 1568869568
Provider Name (Legal Business Name): LORIE GEARHART MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 BAY AVE STE 206
CAPITOLA CA
95010-2102
US

IV. Provider business mailing address

820 BAY AVE STE 206
CAPITOLA CA
95010-2102
US

V. Phone/Fax

Practice location:
  • Phone: 831-427-3100
  • Fax: 831-515-7037
Mailing address:
  • Phone: 831-427-3100
  • Fax: 831-515-7037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LORIE GEARHART
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 831-427-3100