Healthcare Provider Details

I. General information

NPI: 1750490702
Provider Name (Legal Business Name): RANDY TAYLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 N HOLLENBECK AVE STE 200
COVINA CA
91722-1558
US

IV. Provider business mailing address

1433 N HOLLENBECK AVE STE 200
COVINA CA
91722-1558
US

V. Phone/Fax

Practice location:
  • Phone: 626-331-2209
  • Fax: 626-967-1410
Mailing address:
  • Phone: 626-331-2209
  • Fax: 626-967-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC42157
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3987
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: