Healthcare Provider Details

I. General information

NPI: 1669397188
Provider Name (Legal Business Name): ROBYN SMITH TAYLOR PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 MADERA ST
LEMON GROVE CA
91945-3525
US

IV. Provider business mailing address

1600 FOLKESTONE ST
SPRING VALLEY CA
91977-3729
US

V. Phone/Fax

Practice location:
  • Phone: 619-825-5621
  • Fax:
Mailing address:
  • Phone: 619-825-5674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240189265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: