Healthcare Provider Details

I. General information

NPI: 1053308239
Provider Name (Legal Business Name): JAMES DANIEL TAFT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2438 N PONDEROSA DR STE C105
CAMARILLO CA
93010-2465
US

IV. Provider business mailing address

6399 SAN IGNACIO AVE STE 120
SAN JOSE CA
95119-1215
US

V. Phone/Fax

Practice location:
  • Phone: 805-388-2068
  • Fax: 805-484-7700
Mailing address:
  • Phone: 408-369-5620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number192431
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number20A6512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: