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General NPI Number Information
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NPI Number | 1598391468
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Entity Type | Individual
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Provider Name | TAYLOR SOUTHWORTH MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2020
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Last Update Date | 03/22/2020
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Provider Practice Location Address
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Address Line | 2051 MARENGO ST
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City | LOS ANGELES
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State | CA
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Zip | 90033-1352
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Country | US
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Telephone | 630-747-3473
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Fax |
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Provider Business Mailing Address
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Address Line | 4446 GILBERT AVE
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City | WESTERN SPRINGS
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State | IL
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Zip | 60558-1642
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Country | US
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Telephone | 630-747-3473
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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 | 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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