Healthcare Provider Details

I. General information

NPI: 1699908541
Provider Name (Legal Business Name): CHARLOTTE EINARSON TAYLOR LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MISSION ST SUITE C2
SOUTH PASADENA CA
91030-3038
US

IV. Provider business mailing address

630 MISSION ST SUITE C2
SOUTH PASADENA CA
91030-3038
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-3040
  • Fax: 626-403-3042
Mailing address:
  • Phone: 626-403-3040
  • Fax: 626-403-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberEY1643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: