Provider Demographics
NPI:1649419722
Name:TAYLOR, ELSIE BELINDA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ELSIE
Middle Name:BELINDA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 939
Mailing Address - Street 2:
Mailing Address - City:HERLONG
Mailing Address - State:CA
Mailing Address - Zip Code:96113
Mailing Address - Country:US
Mailing Address - Phone:323-820-7181
Mailing Address - Fax:
Practice Address - Street 1:742-450 HERLONG ACCESS RD
Practice Address - Street 2:
Practice Address - City:HERLONG
Practice Address - State:CA
Practice Address - Zip Code:96113
Practice Address - Country:US
Practice Address - Phone:530-257-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17921363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical