Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A143448 | CA |
N | 207Q00000X | Family Doctor | MT204826 | PA |
Y | 207QS0010X | Family Doctor - Sports Medicine | A143448 | CA |
NPI | 1073950754 |
---|---|
Provider Name | Rajiv Tailor |
First Address | Rancho Mirage, CA 92270-3221 |
Second Address | Rancho Mirage, CA 92270-3221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2013 |
Last Update Date | 12/08/2021 |