Healthcare Provider Details

I. General information

NPI: 1659920403
Provider Name (Legal Business Name): STEPHANIE J TARLE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 OUTLET CENTER DR STE 470
OXNARD CA
93036-0611
US

IV. Provider business mailing address

2200 OUTLET CENTER DR STE 470
OXNARD CA
93036-0611
US

V. Phone/Fax

Practice location:
  • Phone: 805-242-8077
  • Fax:
Mailing address:
  • Phone: 805-242-8077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: