Provider Demographics
NPI:1427185610
Name:TAITZ, NANCY BETH (MS)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:BETH
Last Name:TAITZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4293 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1313
Mailing Address - Country:US
Mailing Address - Phone:415-668-0118
Mailing Address - Fax:415-668-0148
Practice Address - Street 1:4293 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1313
Practice Address - Country:US
Practice Address - Phone:415-668-0118
Practice Address - Fax:415-668-0148
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1410231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGAU000700Medicaid
CA3874233Medicare UPIN
CAZZZ01502ZMedicare ID - Type Unspecified