Provider Demographics
NPI:1871629477
Name:TAYLAN, ATHENA VILLASENOR (MD)
Entity Type:Individual
Prefix:DR
First Name:ATHENA
Middle Name:VILLASENOR
Last Name:TAYLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ATHENA
Other - Middle Name:SILVA
Other - Last Name:VILLASENOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4694 GRESHAM DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7624
Mailing Address - Country:US
Mailing Address - Phone:916-941-7567
Mailing Address - Fax:
Practice Address - Street 1:768 MOUNTAIN RANCH RD
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-9707
Practice Address - Country:US
Practice Address - Phone:209-736-0813
Practice Address - Fax:209-736-9088
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA066587208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics