MEDICARE: TAYLOR GATTIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95025196	CA

General Provider Information

NPI Number	:	1891572681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR GATTIS

Provider Business Mailing Address
First Line	:	5255 MELVIN AVE
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-2945
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10850 WILSHIRE BLVD STE 850
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4608
Country	:	US
Telephone Number	:	424-226-6128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	09/13/2023

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Directions to “ TAYLOR GATTIS ” Practice Location

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