Healthcare Provider Details

I. General information

NPI: 1316183353
Provider Name (Legal Business Name): MR. MARTY TAYLOR JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 SKYWAY
PARADISE CA
95969-3280
US

IV. Provider business mailing address

7200 SKYWAY
PARADISE CA
95969-3280
US

V. Phone/Fax

Practice location:
  • Phone: 530-877-1965
  • Fax: 530-872-7896
Mailing address:
  • Phone: 530-877-1965
  • Fax: 530-872-7896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: