Provider Demographics
NPI:1093524043
Name:TAYLOR DOVALA PHD A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:TAYLOR DOVALA PHD A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:DOVALA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-207-0593
Mailing Address - Street 1:11500 W OLYMPIC BLVD STE 460
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1562
Mailing Address - Country:US
Mailing Address - Phone:323-207-0593
Mailing Address - Fax:
Practice Address - Street 1:11500 W OLYMPIC BLVD STE 460
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1562
Practice Address - Country:US
Practice Address - Phone:323-207-0593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health