Healthcare Provider Details

I. General information

NPI: 1144308842
Provider Name (Legal Business Name): LYN TAYLOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 SUTTER PLACE
DAVIS CA
95616
US

IV. Provider business mailing address

43351 ALMOND LN
DAVIS CA
95618-5060
US

V. Phone/Fax

Practice location:
  • Phone: 530-758-2060
  • Fax:
Mailing address:
  • Phone: 530-756-3079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG40145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: