Healthcare Provider Details

I. General information

NPI: 1164438255
Provider Name (Legal Business Name): JOSHUA MANN TAYLOR PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST SUITE 400
SANTA ANA CA
92701-4519
US

IV. Provider business mailing address

405 W 5TH ST SUITE 400
SANTA ANA CA
92701-4519
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-3840
  • Fax:
Mailing address:
  • Phone: 714-834-3840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB31319
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: