Healthcare Provider Details

I. General information

NPI: 1083648877
Provider Name (Legal Business Name): CYNTHIA L. TAYLOR, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14212 AMBAUM BLVD SW SUITE 106
BURIEN WA
98166-1449
US

IV. Provider business mailing address

PO BOX 6989
PORTLAND OR
97228-6989
US

V. Phone/Fax

Practice location:
  • Phone: 206-244-5520
  • Fax: 206-957-0034
Mailing address:
  • Phone: 206-439-4888
  • Fax: 206-242-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberWA00025830
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number00025830
License Number StateWA

VIII. Authorized Official

Name: CYNTHIA TAYLOR
Title or Position: OWNER
Credential: MD
Phone: 206-244-5520