Basic Information
| Provider Information | |||||||||
| NPI: | 1124647144 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | PATRICIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1329 | ||||||||
| Address2: | |||||||||
| City: | SAN CARLOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940707329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6508179070 | ||||||||
| FaxNumber: | 6508179074 | ||||||||
| Practice Location | |||||||||
| Address1: | 1633 BAYSHORE HWY STE 155 | ||||||||
| Address2: | |||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940101515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503764230 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2020 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.