Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 95010879 | CA |
NPI | 1205391356 |
---|---|
Provider Name | Mr. Antoine Vernell Taylor SR. |
First Address | North Hills, CA 91343-1018 |
Second Address | Los Angeles, CA 90027-6098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2019 |
Last Update Date | 04/02/2019 |