Provider Demographics
NPI:1568635647
Name:TAYLOR, SILLA PAPE (LAC)
Entity Type:Individual
Prefix:
First Name:SILLA
Middle Name:PAPE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 ELWOOD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1947
Mailing Address - Country:US
Mailing Address - Phone:510-703-9794
Mailing Address - Fax:510-336-0147
Practice Address - Street 1:495 ELWOOD AVE APT 1
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1947
Practice Address - Country:US
Practice Address - Phone:510-703-9794
Practice Address - Fax:510-336-0147
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8392171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist