Healthcare Provider Details

I. General information

NPI: 1548028806
Provider Name (Legal Business Name): TAYLOR DURHAM MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE # 8M
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

3728 WALL AVE
RICHMOND CA
94804-3346
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: