Healthcare Provider Details

I. General information

NPI: 1437217767
Provider Name (Legal Business Name): JAMIE LATIOLAIS TAYLOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 E MARIPOSA AVE
EL SEGUNDO CA
90245
US

IV. Provider business mailing address

2040 E MARIPOSA AVE
EL SEGUNDO CA
90245-5027
US

V. Phone/Fax

Practice location:
  • Phone: 310-400-0645
  • Fax: 424-270-6232
Mailing address:
  • Phone: 310-400-0645
  • Fax: 424-270-6232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberA86675
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA86675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: