Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 20A11540 | CA |
Y | 111NI0900X | Internist | 20A11540 | CA |
NPI | 1003116674 |
---|---|
Provider Name | Tiffney Taylor |
First Address | Santa Maria, CA 93454 |
Second Address | Templeton, CA 93465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2010 |
Last Update Date | 24/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B6428626 | DRIVERS LICENSE (01) | CA |