Healthcare Provider Details

I. General information

NPI: 1376188375
Provider Name (Legal Business Name): TAYLOR POMARES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR JACKSON

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 ARNOLD DR STE 148
MARTINEZ CA
94553-6538
US

IV. Provider business mailing address

2080 N TUSTIN AVE STE B
SANTA ANA CA
92705-7875
US

V. Phone/Fax

Practice location:
  • Phone: 510-268-8120
  • Fax:
Mailing address:
  • Phone: 855-581-0100
  • Fax: 949-709-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-68562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: