Healthcare Provider Details

I. General information

NPI: 1336176312
Provider Name (Legal Business Name): CECILLE G TAYLOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 CREEKSIDE DR #160
FOLSOM CA
95630
US

IV. Provider business mailing address

1615 CREEKSIDE DR #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:
Title or Position:
Credential:
Phone: