Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 53941 | CA |
NPI | 1043497050 |
---|---|
Provider Name | Kelly Ryan Taylor |
First Address | Carlsbad, CA 92008-1950 |
Second Address | Carlsbad, CA 92008-1950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2008 |
Last Update Date | 08/06/2011 |