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General NPI Number Information
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NPI Number | 1003787250
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Entity Type | Individual
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Provider Name | TAYLOR CLARK PHD
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Gender | Female
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Dates
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Enumeration Date | 09/12/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 3350 VILLA LA JOLLA DRIVE
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City | SAN DIEGO
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State | CA
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Zip | 92161-0001
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Country | US
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Telephone | 619-375-7685
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Fax |
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Provider Business Mailing Address
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Address Line | 11172 VISTA SORRENTO PKWY APT 305
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City | SAN DIEGO
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State | CA
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Zip | 92130-7616
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 36161
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License Number State | CA
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