Healthcare Provider Details

I. General information

NPI: 1316305444
Provider Name (Legal Business Name): TAYZHA KEHAUNANI DUDOIT BT, BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11037 WARNER AVE #339
FOUNTAIN VALLEY CA
92708-4007
US

IV. Provider business mailing address

11037 WARNER AVE #339
FOUNTAIN VALLEY CA
92708-4007
US

V. Phone/Fax

Practice location:
  • Phone: 800-273-4292
  • Fax: 949-253-4627
Mailing address:
  • Phone: 800-273-4292
  • Fax: 949-253-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: