Provider Demographics
NPI:1861439382
Name:LAYTON, KENT B (PSYD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:B
Last Name:LAYTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 PARKWAY DR
Mailing Address - Street 2:SUITE 113
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1534
Mailing Address - Country:US
Mailing Address - Phone:619-589-0552
Mailing Address - Fax:619-589-0205
Practice Address - Street 1:7200 PARKWAY DR
Practice Address - Street 2:SUITE 113
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1534
Practice Address - Country:US
Practice Address - Phone:619-589-0552
Practice Address - Fax:619-589-0205
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17305103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY17305Medicare UPIN
CACP17305Medicare ID - Type Unspecified