Provider Demographics
NPI:1003034166
Name:TAYLOR, BRENT (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29520 HYPERION ST
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2775
Mailing Address - Country:US
Mailing Address - Phone:619-594-3871
Mailing Address - Fax:
Practice Address - Street 1:2423 CAMINO DEL RIO S STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3734
Practice Address - Country:US
Practice Address - Phone:619-594-3871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37311106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist