Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 54555 | CA |
NPI | 1013399963 |
---|---|
Provider Name | Taylor Nicole Leigh |
First Address | Santa Monica, CA 90405-1320 |
Second Address | Santa Monica, CA 90405-1320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2015 |
Last Update Date | 18/02/2021 |