Healthcare Provider Details

I. General information

NPI: 1801638499
Provider Name (Legal Business Name): TAYLOR PAVLOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7725 GATEWAY UNIT 2306
IRVINE CA
92618-5822
US

IV. Provider business mailing address

7725 GATEWAY UNIT 2306
IRVINE CA
92618-5822
US

V. Phone/Fax

Practice location:
  • Phone: 818-661-8760
  • Fax:
Mailing address:
  • Phone: 818-661-8760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: