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General NPI Number Information
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NPI Number | 1083805865
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Entity Type | Individual
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Provider Name | SUSAN A. TAYLOR PA
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Gender | Female
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 711-045 CENTER ROAD CALIFORNIA CORRECTIONAL CENTER
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City | SUSANVILLE
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State | CA
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Zip | 96130
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Country | US
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Telephone | 530-257-2181
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Fax |
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Provider Business Mailing Address
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Address Line | 701-670 RICHMOND RD E
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City | SUSANVILLE
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State | CA
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Zip | 96130-5020
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Country | US
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Telephone | 530-251-2136
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 15318
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License Number State | CA
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