Healthcare Provider Details

I. General information

NPI: 1306955349
Provider Name (Legal Business Name): LORI B TAYLOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12845 POINTE DEL MAR WAY SUITE 200
DEL MAR CA
92014-3862
US

IV. Provider business mailing address

12845 POINTE DEL MAR WAY SUITE 200
DEL MAR CA
92014-3862
US

V. Phone/Fax

Practice location:
  • Phone: 858-794-7337
  • Fax: 858-794-7338
Mailing address:
  • Phone: 858-794-7337
  • Fax: 858-794-7338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA 055826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: