Healthcare Provider Details

I. General information

NPI: 1134491988
Provider Name (Legal Business Name): THOMAS TAYLOR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST STE 214
PASADENA CA
91106-2401
US

IV. Provider business mailing address

960 E GREEN ST STE 214
PASADENA CA
91106-2401
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-7730
  • Fax:
Mailing address:
  • Phone: 626-577-7730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberG66279
License Number StateCA

VIII. Authorized Official

Name: DR. THOMAS TAYLOR
Title or Position: OWNER
Credential: M.D.
Phone: 626-577-7730