Healthcare Provider Details

I. General information

NPI: 1255262234
Provider Name (Legal Business Name): OLIVER TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT ST
BERKELEY CA
94705-2190
US

IV. Provider business mailing address

3101 TELEGRAPH AVE
BERKELEY CA
94705-1984
US

V. Phone/Fax

Practice location:
  • Phone: 510-812-7084
  • Fax: 341-946-6182
Mailing address:
  • Phone: 510-812-7084
  • Fax: 341-946-6182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: