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General NPI Number Information
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NPI Number | 1558242818
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Entity Type | Individual
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Provider Name | TAYLOR MARCELLA WATSON
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Gender | Female
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Dates
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Enumeration Date | 09/11/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 7200 BANCROFT AVE STE 267
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City | OAKLAND
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State | CA
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Zip | 94605-2408
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Country | US
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Telephone | 510-735-0864
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Fax | 510-647-9408
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Provider Business Mailing Address
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Address Line | 1919 ADDISON ST STE 204
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City | BERKELEY
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State | CA
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Zip | 94704-1143
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Country | US
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Telephone | 510-899-7445
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Fax | 510-647-9408
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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