Provider Demographics
NPI:1275757700
Name:TAYLOR, ZACKARY WILLIS
Entity Type:Individual
Prefix:
First Name:ZACKARY
Middle Name:WILLIS
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 1:9961 SIERRA AVE
Mailing Address - Street 2:MOB 2 PEDIATRICS
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6720
Mailing Address - Country:US
Mailing Address - Phone:909-427-7132
Mailing Address - Fax:909-427-5033
Practice Address - Street 1:9961 SIERRA AVE
Practice Address - Street 2:MOB 2 PEDIATRICS
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:909-427-7132
Practice Address - Fax:909-427-5033
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA885772080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases