Provider Demographics
NPI:1437217767
Name:TAYLOR, JAMIE LATIOLAIS (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LATIOLAIS
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 E MARIPOSA AVE
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-5027
Mailing Address - Country:US
Mailing Address - Phone:310-400-0645
Mailing Address - Fax:424-270-6232
Practice Address - Street 1:2040 E MARIPOSA AVE
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245
Practice Address - Country:US
Practice Address - Phone:310-400-0645
Practice Address - Fax:424-270-6232
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86675207LC0200X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA86675AMedicare PIN