Healthcare Provider Details

I. General information

NPI: 1528144433
Provider Name (Legal Business Name): TASHA KATHERINE TAYLOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3177 OCEAN VIEW BLVD
SAN DIEGO CA
92113-1498
US

IV. Provider business mailing address

3678 CAMINITO CARMEL LANDING
SAN DIEGO CA
92130
US

V. Phone/Fax

Practice location:
  • Phone: 619-237-9300
  • Fax: 619-631-7043
Mailing address:
  • Phone: 858-259-1549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA82187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: