Provider Demographics
NPI:1063083376
Name:MARIENTHAL, TAYLOR DANIELLE (LM,CPM)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DANIELLE
Last Name:MARIENTHAL
Suffix:
Gender:F
Credentials:LM,CPM
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:DANIELLE
Other - Last Name:STICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LM, CPM
Mailing Address - Street 1:7106 E BREIGHTON CIR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-2317
Mailing Address - Country:US
Mailing Address - Phone:714-878-1938
Mailing Address - Fax:714-707-4115
Practice Address - Street 1:1001 W 17TH ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4512
Practice Address - Country:US
Practice Address - Phone:714-878-1938
Practice Address - Fax:714-707-4115
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA643176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty