Healthcare Provider Details

I. General information

NPI: 1215424262
Provider Name (Legal Business Name): DANIELLE DENISE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ESSEX ST STE 122
SAN FRANCISCO CA
94105-3195
US

IV. Provider business mailing address

25 ESSEX ST STE 122
SAN FRANCISCO CA
94105-3195
US

V. Phone/Fax

Practice location:
  • Phone: 415-767-3411
  • Fax: 415-977-0168
Mailing address:
  • Phone: 415-767-3411
  • Fax: 415-977-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: