Healthcare Provider Details

I. General information

NPI: 1316246770
Provider Name (Legal Business Name): ANGELIQUE B. TAYLOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 FOOTHILL BLVD
OAKLAND CA
94606-3011
US

IV. Provider business mailing address

819 FOOTHILL BLVD
OAKLAND CA
94606-3011
US

V. Phone/Fax

Practice location:
  • Phone: 510-286-8300
  • Fax: 510-286-8311
Mailing address:
  • Phone: 510-286-8300
  • Fax: 510-286-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP 20052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: