Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY11047 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY11047 | CA |
NPI | 1003838376 |
---|---|
Provider Name | Robert S Tasoff |
First Address | Burbank, CA 91502-2571 |
Second Address | Burbank, CA 91502-2571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |