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General NPI Number Information
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NPI Number | 1184285371
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Entity Type | Individual
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Provider Name | TAYLOR MARIE BOURELLE
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Gender | Female
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Dates
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Enumeration Date | 06/27/2019
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 2901 SILLECT AVE STE 100
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City | BAKERSFIELD
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State | CA
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Zip | 93308-6372
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Country | US
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Telephone | 661-323-8384
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 SILLECT AVE
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City | BAKERSFIELD
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State | CA
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Zip | 93308-6371
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Country | US
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Telephone | 660-323-8384
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA56946
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License Number State | CA
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