Healthcare Provider Details

I. General information

NPI: 1366796591
Provider Name (Legal Business Name): MARK G. TAYLOR LAC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 E 2ND ST
LONG BEACH CA
90803-5164
US

IV. Provider business mailing address

3025 E 2ND ST
LONG BEACH CA
90803-5164
US

V. Phone/Fax

Practice location:
  • Phone: 562-225-9360
  • Fax:
Mailing address:
  • Phone: 562-225-9360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: