Healthcare Provider Details

I. General information

NPI: 1073633632
Provider Name (Legal Business Name): TANYA KHEMET TAIWO LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 12/24/2019
Certification Date: 12/24/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 JOHN JONES RD
DAVIS CA
95616-9701
US

IV. Provider business mailing address

2171 SARAZEN AVE
SACRAMENTO CA
95822-4128
US

V. Phone/Fax

Practice location:
  • Phone: 530-758-2060
  • Fax:
Mailing address:
  • Phone: 916-558-4800
  • Fax: 916-447-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: