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General NPI Number Information
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NPI Number | 1366082802
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Entity Type | Organization
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Legal Business Name | KAILA SMITH PSY D PSYCHOLOGIST INC
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 4080 CENTRE ST STE 202
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City | SAN DIEGO
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State | CA
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Zip | 92103-2657
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Country | US
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Telephone | 619-880-0193
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Fax | 619-860-1264
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Provider Business Mailing Address
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Address Line | 4080 CENTRE ST STE 202
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City | SAN DIEGO
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State | CA
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Zip | 92103-2657
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Country | US
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Telephone | 619-880-0193
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Fax | 619-860-1264
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAILA SMITH
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Credential | PSY D PSYCHOLOGIST
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Telephone | 619-880-0193
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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 |
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License Number State |
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