Healthcare Provider Details

I. General information

NPI: 1649877879
Provider Name (Legal Business Name): JOSHUA WAYNE TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-5018
US

IV. Provider business mailing address

516 HILLTOP DR
CHULA VISTA CA
91910-6124
US

V. Phone/Fax

Practice location:
  • Phone: 972-467-2429
  • Fax:
Mailing address:
  • Phone: 972-467-2429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: