Healthcare Provider Details

I. General information

NPI: 1932980968
Provider Name (Legal Business Name): TAYLOR IMAN- LOREN MOTTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3845 39TH AVE APT 1
OAKLAND CA
94619-2042
US

IV. Provider business mailing address

3845 39TH AVE APT 1
OAKLAND CA
94619-2042
US

V. Phone/Fax

Practice location:
  • Phone: 510-282-0063
  • Fax:
Mailing address:
  • Phone: 510-282-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95415390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: