Basic Information
| Provider Information | |||||||||
| NPI: | 1003494204 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 E IMPERIAL HWY | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144477000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14140 BEACH BLVD STE 223 | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926834453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148961566 | ||||||||
| FaxNumber: | 7148967408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2021 | ||||||||
| LastUpdateDate: | 04/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.