Provider Demographics
NPI:1639167786
Name:TAYAO, MARIA CONCEPCION L (MD)
Entity Type:Individual
Prefix:
First Name:MARIA CONCEPCION
Middle Name:L
Last Name:TAYAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA CONCEPCION
Other - Middle Name:LOPEZ
Other - Last Name:TAYAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13110 ELK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7182
Mailing Address - Country:US
Mailing Address - Phone:813-349-7568
Mailing Address - Fax:813-349-7561
Practice Address - Street 1:502 N MOBLEY ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-2904
Practice Address - Country:US
Practice Address - Phone:813-341-7450
Practice Address - Fax:813-341-7461
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80067208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259971600Medicaid