Healthcare Provider Details

I. General information

NPI: 1205380193
Provider Name (Legal Business Name): TAYLOR HAYNES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10811 WASHINGTON BLVD
CULVER CITY CA
90232-3659
US

IV. Provider business mailing address

6306 TUNNEY AVE
TARZANA CA
91335-6561
US

V. Phone/Fax

Practice location:
  • Phone: 310-945-3350
  • Fax: 310-945-3356
Mailing address:
  • Phone: 626-590-3687
  • Fax: 310-945-3356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number125082
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: