1871629477 NPI number — DR. ATHENA VILLASENOR TAYLAN MD

Table of content: DR. ATHENA VILLASENOR TAYLAN MD (NPI 1871629477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871629477 NPI number — DR. ATHENA VILLASENOR TAYLAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLAN
Provider First Name:
ATHENA
Provider Middle Name:
VILLASENOR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VILLASENOR
Provider Other First Name:
ATHENA
Provider Other Middle Name:
SILVA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871629477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4694 GRESHAM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL DORADO HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95762-7624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-941-7567
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
768 MOUNTAIN RANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANDREAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95249-9707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-736-0813
Provider Business Practice Location Address Fax Number:
209-736-9088
Provider Enumeration Date:
02/26/2007

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: 208000000X , with the licence number:  A066587 , 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)





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