Healthcare Provider Details

I. General information

NPI: 1528130846
Provider Name (Legal Business Name): DAISY NAUROTH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FOSTER RD
SANTA MARIA CA
93455-3620
US

IV. Provider business mailing address

500 W FOSTER RD
SANTA MARIA CA
93455-3620
US

V. Phone/Fax

Practice location:
  • Phone: 805-934-6380
  • Fax:
Mailing address:
  • Phone: 805-934-6380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: