Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | A88577 | CA |
NPI | 1275757700 |
---|---|
Provider Name | Zackary Willis Taylor |
First Address | Fontana, CA 92335-6720 |
Second Address | Fontana, CA 92335-6720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 03/12/2021 |