Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY12459 | CA |
NPI | 1245395680 |
---|---|
Provider Name | Matthew Tarran |
First Address | Cupertino, CA 95014-0712 |
Second Address | Cupertino, CA 95014-0712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 11/02/2022 |