Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95018608 | CA |
NPI | 1033704572 |
---|---|
Provider Name | Olivia Taylor Defilippo |
First Address | Newport Beach, CA 92660-8105 |
Second Address | Newport Beach, CA 92660-8105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2021 |
Last Update Date | 15/12/2021 |