Provider Demographics
NPI:1033684774
Name:PEARL, TARYN ALEXANDRA
Entity Type:Individual
Prefix:MRS
First Name:TARYN
Middle Name:ALEXANDRA
Last Name:PEARL
Suffix:
Gender:F
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:892 AEROVISTA PL
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-8054
Mailing Address - Country:US
Mailing Address - Phone:805-395-3277
Mailing Address - Fax:805-541-1203
Practice Address - Street 1:892 AEROVISTA PL
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-8054
Practice Address - Country:US
Practice Address - Phone:805-395-3277
Practice Address - Fax:805-541-1203
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant