Healthcare Provider Details

I. General information

NPI: 1013063379
Provider Name (Legal Business Name): MS. KERI DAWN TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 NORTH BROADWAY SUITE 200
SANTA ANA CA
92706
US

IV. Provider business mailing address

2215 NORTH BROADWAY SUITE 200
SANTA ANA CA
92706
US

V. Phone/Fax

Practice location:
  • Phone: 714-221-6400
  • Fax: 714-221-6401
Mailing address:
  • Phone: 714-221-6400
  • Fax: 714-221-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: