Healthcare Provider Details

I. General information

NPI: 1396669735
Provider Name (Legal Business Name): KAYLEIGH TAYLOR SUDRC #24855
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 CAMINO DEL RIO S STE 300
SAN DIEGO CA
92108
US

IV. Provider business mailing address

1011 CAMINO DEL RIO S STE 300
SAN DIEGO CA
92108
US

V. Phone/Fax

Practice location:
  • Phone: 619-287-8225
  • Fax: 619-393-0386
Mailing address:
  • Phone: 619-287-8225
  • Fax: 619-393-0386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: