Healthcare Provider Details

I. General information

NPI: 1194977074
Provider Name (Legal Business Name): CECILLE TAYLOR MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 CREEKSIDE DR SUITE 110
FOLSOM CA
95630-3491
US

IV. Provider business mailing address

1615 CREEKSIDE DR SUITE 110
FOLSOM CA
95630-3491
US

V. Phone/Fax

Practice location:
  • Phone: 916-983-4550
  • Fax: 916-983-8569
Mailing address:
  • Phone: 916-983-4550
  • Fax: 916-983-8569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG067853
License Number StateCA

VIII. Authorized Official

Name: DR. CECILLE GLYNIS TAYLOR
Title or Position: PRESIDENT
Credential: MD
Phone: 916-983-4550