Provider Demographics
NPI:1568609600
Name:TAUB, JAY
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:TAUB
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 1:4021 RIVA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-6426
Mailing Address - Country:US
Mailing Address - Phone:916-967-4902
Mailing Address - Fax:916-966-8156
Practice Address - Street 1:4021 RIVA RIDGE DR
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-6426
Practice Address - Country:US
Practice Address - Phone:916-967-4902
Practice Address - Fax:916-966-8156
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22963207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology