Healthcare Provider Details

I. General information

NPI: 1487564498
Provider Name (Legal Business Name): TAYLOR ERMOIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17000 HAYNES ST
LAKE BALBOA CA
91406-5420
US

IV. Provider business mailing address

5637 STROHM AVE APT 8
NORTH HOLLYWOOD CA
91601-2214
US

V. Phone/Fax

Practice location:
  • Phone: 818-758-5200
  • Fax: 818-450-0119
Mailing address:
  • Phone: 785-259-5124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number122194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: