Individual
TARA L VICTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
760 WESTWOOD PLAZA, LOS ANGELES, CA 90095-8353
(310) 825-9989
Mailing address
2308 SCHADER DR, 107, SANTA MONICA, CA 90404-2946
(310) 478-3711
(310) 268-4935
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY21150
CA
103TC0700X
Clinical Psychologist
PSY 21150
CA
Other
Enumeration date
10/24/2006
Last updated
03/24/2009
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