Theodora Gore, NURSE PRACTIONER

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

RN522355 Issued in CA

Practice address

4650 W Sunset Blvd # 53
Los Angeles, CA 90027-6062

Phone

(323) 361-7730

NPI assigned

Apr 11, 2007

Last updated

Oct 11, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507680000000",
    "number": "1689897902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1814 ARMOUR LANE",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "90278",
            "telephone_number": "310-379-2106",
            "fax_number": "310-680-9350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD # 53",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062",
            "telephone_number": "323-361-7730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORE",
        "first_name": "THEODORA",
        "credential": "NURSE PRACTIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-11",
        "last_updated": "2017-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "CA",
            "license": "RN522355",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "RN522355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gordons Grace II Co. (Gordons Grace II)
• Whitney Jade Gordy
• Joyti Gore
• Lana Gore, PHARM.D.
• Paul Gore, PHD
• Shavonne Goree-Petty
• Amanda Sue Goree, RADT
• Elaine Gorelik, DDS
• Mariya Gorelik, MS, CCC-SLP
• Yitzhar Efraim Goretsky, MD

• Psychiatric/Mental Health Registered Nurse in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Psychiatric/Mental Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.