=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215828744
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAMAR YSABEL TAZI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2025
-----------------------------------------------------
Last Update Date | 07/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3102 E HIGHLAND AVE
-----------------------------------------------------
City | PATTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92369-7813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-373-0476
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27431 SAN BERNARDINO AVE APT 256
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92374-5086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TF0200X
-----------------------------------------------------
Taxonomy Name | Forensic Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------