Healthcare Provider Details

I. General information

NPI: 1083593883
Provider Name (Legal Business Name): TAYLOR RAE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1663 MISSION ST STE 604
SAN FRANCISCO CA
94103-2473
US

IV. Provider business mailing address

494 29TH AVE APT 5
SAN FRANCISCO CA
94121-1748
US

V. Phone/Fax

Practice location:
  • Phone: 415-474-7310
  • Fax:
Mailing address:
  • Phone: 530-605-7301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: