Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 28183 | CA |
NPI | 1134582299 |
---|---|
Provider Name | Dr. Taylor Foster Smith |
First Address | San Luis Obispo, CA 93401-2957 |
Second Address | San Luis Obispo, CA 93401-2957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2016 |
Last Update Date | 05/04/2016 |