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NPI Code Detail

MEDICARE: MR. EVERETT M TAYLOR B.S.

MEDICARE: MR. EVERETT M TAYLOR B.S.
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1912142910
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EVERETT M TAYLOR B.S.
Provider Business Mailing Address
First Line : 2644 30TH ST STE 100
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-3051
Country : US
Telephone Number : 310-314-6200
Fax Number : 310-450-2024
Provider Business Practice Location Address
First Line : 2644 30TH ST STE 100
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-3051
Country : US
Telephone Number : 310-314-6200
Fax Number : 310-450-2024
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2008
Last Update Date : 09/11/2020

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