Provider Demographics
NPI:1598171159
Name:TAUT, AMELIA
Entity Type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:
Last Name:TAUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6730
Mailing Address - Country:US
Mailing Address - Phone:888-499-9303
Mailing Address - Fax:323-889-7821
Practice Address - Street 1:1814 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:888-499-9303
Practice Address - Fax:323-889-7821
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA159106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine