Provider Demographics
NPI:1871637249
Name:CAYLOR, PHILIP HARRY (LAC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:HARRY
Last Name:CAYLOR
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 WATER ST STE C3
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4128
Mailing Address - Country:US
Mailing Address - Phone:831-359-4223
Mailing Address - Fax:831-603-7054
Practice Address - Street 1:550 WATER ST STE C3
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4128
Practice Address - Country:US
Practice Address - Phone:831-359-4223
Practice Address - Fax:831-603-7054
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3246171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC3246OtherLISCENCED ACUPUNCTURIST
CAAC3246Medicaid