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General NPI Number Information
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NPI Number | 1346315447
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Entity Type | Individual
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Provider Name | TARA C BOOTH PSY. D
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Gender | Female
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 1675 MORENA BLVD SUITE 100
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City | SAN DIEGO
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State | CA
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Zip | 92110-3703
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Country | US
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Telephone | 619-275-8000
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Fax | 619-275-8005
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Provider Business Mailing Address
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Address Line | 1675 MORENA BLVD SUITE 100
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City | SAN DIEGO
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State | CA
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Zip | 92110-3703
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Country | US
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Telephone | 619-275-8000
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Fax | 619-275-8005
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY19590
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License Number State | CA
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