MEDICARE: TAYLOR KATHLEEN MERIDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	1041C0700X	Clinical Social Worker	138489	CA
3	104100000X	Social Worker	110751	CA

General Provider Information

NPI Number	:	1679220909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR KATHLEEN MERIDA

Provider Business Mailing Address
First Line	:	4950 WARING RD STE 4
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-2700
Country	:	US
Telephone Number	:	619-660-3886
Fax Number	:

Provider Business Practice Location Address
First Line	:	5104 ELIOT ST
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92057-2646
Country	:	US
Telephone Number	:	760-637-2340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	06/03/2026

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