Healthcare Provider Details

I. General information

NPI: 1861460768
Provider Name (Legal Business Name): GRETCHEN COLLINS TAYLOR M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 05/19/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 477 BOX 555191 US NAVAL HOSPITAL CAMP PENDLETON
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

3191 ORA AVO TER
VISTA CA
92084-6511
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1480
  • Fax:
Mailing address:
  • Phone: 760-599-5867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG68857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: