Provider Demographics
NPI:1275393191
Name:TAYLOR, STEPHON
Entity Type:Individual
Prefix:
First Name:STEPHON
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1898 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1733
Mailing Address - Country:US
Mailing Address - Phone:408-928-1700
Mailing Address - Fax:408-928-1701
Practice Address - Street 1:1898 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1733
Practice Address - Country:US
Practice Address - Phone:408-928-1700
Practice Address - Fax:408-928-1701
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator