1568486660 NPI number — DENNIS L TAYLOR

Table of content: HASNAIN KARAN (NPI 1164116828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568486660 NPI number — DENNIS L TAYLOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
DENNIS
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAYLOR
Provider Other First Name:
DENNIS
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1568486660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
578 RIO LINDO AVE
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
CHICO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95926-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-894-6195
Provider Business Mailing Address Fax Number:
530-894-6199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
578 RIO LINDO AVE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-894-6195
Provider Business Practice Location Address Fax Number:
530-894-6199
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  E3004 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000E30041 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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