Healthcare Provider Details

I. General information

NPI: 1699038950
Provider Name (Legal Business Name): LAURA TAYLOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 11/27/2023
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SAN PABLO ST STE 1300
LOS ANGELES CA
90033-5312
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-5900
  • Fax:
Mailing address:
  • Phone: 323-442-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC165933
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.134317
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: