Healthcare Provider Details

I. General information

NPI: 1194137828
Provider Name (Legal Business Name): ALEXANDER JOSEPH TAURAS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 MAGNOLIA AVE
LOS ANGELES CA
90007-1220
US

IV. Provider business mailing address

808 W 58TH ST
LOS ANGELES CA
90037-3632
US

V. Phone/Fax

Practice location:
  • Phone: 323-541-1411
  • Fax: 323-541-1661
Mailing address:
  • Phone: 323-541-1411
  • Fax: 323-541-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number142564
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: