Healthcare Provider Details

I. General information

NPI: 1962931006
Provider Name (Legal Business Name): TAYLOR DOVALA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2017
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 W OLYMPIC BLVD STE 460
LOS ANGELES CA
90064-1562
US

IV. Provider business mailing address

11500 W OLYMPIC BLVD STE 460
LOS ANGELES CA
90064-1562
US

V. Phone/Fax

Practice location:
  • Phone: 323-207-0593
  • Fax:
Mailing address:
  • Phone: 323-207-0593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: