Provider Demographics
NPI:1851604771
Name:TAYLOR, CAROLYN LEE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MISS
First Name:CAROLYN
Middle Name:LEE
Last Name:TAYLOR
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Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:5371 SANTA CATALINA AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1023
Mailing Address - Country:US
Mailing Address - Phone:714-356-8485
Mailing Address - Fax:310-807-8345
Practice Address - Street 1:321 N LARCHMONT BLVD
Practice Address - Street 2:SUITE 505
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3025
Practice Address - Country:US
Practice Address - Phone:310-975-9546
Practice Address - Fax:310-807-8345
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
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Provider Licenses
StateLicense IDTaxonomies
CAPA19699363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical