Healthcare Provider Details

I. General information

NPI: 1962553487
Provider Name (Legal Business Name): MARSHALL PAUL GOUZE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 MONTGOMERY RD
RED BLUFF CA
96080-4605
US

IV. Provider business mailing address

443 PENINSULA DR
LAKE ALMANOR CA
96137-9683
US

V. Phone/Fax

Practice location:
  • Phone: 530-284-7990
  • Fax: 530-284-1073
Mailing address:
  • Phone: 805-895-1692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY5436
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY4385
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: