Healthcare Provider Details

I. General information

NPI: 1699684662
Provider Name (Legal Business Name): TAYLOR WYATT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 PLAZA DEL AMO
TORRANCE CA
90501-3418
US

IV. Provider business mailing address

1304 S HUDSON AVE
LOS ANGELES CA
90019-3013
US

V. Phone/Fax

Practice location:
  • Phone: 310-972-6981
  • Fax:
Mailing address:
  • Phone: 424-413-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: