MEDICARE: MR. DYLAN SCOTT TAYAG LCSW

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	1041C0700X	Clinical Social Worker	96462	CA

General Provider Information

NPI Number	:	1902281983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DYLAN SCOTT TAYAG LCSW

Provider Business Mailing Address
First Line	:	27431 SAN BERNARDINO AVE APT 73
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92374-5078
Country	:	US
Telephone Number	:	760-505-0328
Fax Number	:

Provider Business Practice Location Address
First Line	:	27431 SAN BERNARDINO AVE APT 73
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92374-5078
Country	:	US
Telephone Number	:	760-230-3752
Fax Number	:

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

Provider Enumeration Date	:	07/20/2015
Last Update Date	:	10/31/2020

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