Provider Demographics
NPI:1366951402
Name:TAYLOR, ENNA EMPERATRIZ (PSYD)
Entity type:Individual
Prefix:DR
First Name:ENNA
Middle Name:EMPERATRIZ
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 VISITACION AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:BRISBANE
Mailing Address - State:CA
Mailing Address - Zip Code:94005-1575
Mailing Address - Country:US
Mailing Address - Phone:415-508-9290
Mailing Address - Fax:
Practice Address - Street 1:44 VISITACION AVE STE 103
Practice Address - Street 2:
Practice Address - City:BRISBANE
Practice Address - State:CA
Practice Address - Zip Code:94005-1575
Practice Address - Country:US
Practice Address - Phone:831-350-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29272103TC0700X
CA29272103TC0700X
103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical