Healthcare Provider Details

I. General information

NPI: 1063917912
Provider Name (Legal Business Name): TAYLOR ANNE COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 02/08/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3539 COLLEGE AVE
SAN DIEGO CA
92115-7032
US

IV. Provider business mailing address

865 THIRD AVE STE 112
CHULA VISTA CA
91911-1300
US

V. Phone/Fax

Practice location:
  • Phone: 619-818-3788
  • Fax: 619-795-6906
Mailing address:
  • Phone: 619-271-7992
  • Fax: 619-271-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number103766
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: