Provider Demographics
NPI:1053362160
Name:AYLOR, ANITA ROBIN (PHD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:ROBIN
Last Name:AYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4136
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93403-4136
Mailing Address - Country:US
Mailing Address - Phone:800-460-9219
Mailing Address - Fax:800-460-9219
Practice Address - Street 1:3033 5TH AVE STE 230
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5873
Practice Address - Country:US
Practice Address - Phone:800-460-9219
Practice Address - Fax:800-460-9219
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16291103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP16291AMedicare ID - Type Unspecified