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General NPI Number Information
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NPI Number | 1982197174
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Entity Type | Organization
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Legal Business Name | TRINH TAYLOR CORP
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 06/12/2018
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Provider Practice Location Address
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Address Line | 16055 VENTURA BLVD STE 1112
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City | ENCINO
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State | CA
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Zip | 91436-2612
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Country | US
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Telephone | 818-723-5435
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Fax | 818-858-1870
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Provider Business Mailing Address
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Address Line | 24342 VISTA HILLS DR
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City | VALENCIA
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State | CA
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Zip | 91355-3130
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Country | US
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Telephone | 818-723-5435
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Fax | 818-858-1870
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Authorized Official
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Title or Position | CEO
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Name | DR. THAO T TAYLOR
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Credential | PSY.D.
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Telephone | 818-723-5435
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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 | PSY24474
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License Number State | CA
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