Provider Demographics
NPI:1962271767
Name:TAYLOR, TABITHA
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 WILLOW AVE APT G6
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1244
Mailing Address - Country:US
Mailing Address - Phone:510-393-4335
Mailing Address - Fax:
Practice Address - Street 1:1231 WILLOW AVE APT G6
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1244
Practice Address - Country:US
Practice Address - Phone:510-393-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula