Healthcare Provider Details

I. General information

NPI: 1104250703
Provider Name (Legal Business Name): CORA TAYLOR M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORA WOOD M.F.T.

II. Dates (important events)

Enumeration Date: 08/30/2013
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1198 MELODY LN STE 113M
ROSEVILLE CA
95678-5100
US

IV. Provider business mailing address

6770 STANFORD RANCH RD # 1223
ROSEVILLE CA
95678-1907
US

V. Phone/Fax

Practice location:
  • Phone: 415-212-8672
  • Fax:
Mailing address:
  • Phone: 415-212-8672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number86950
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: