Provider Demographics
NPI:1891834743
Name:TAYLOR, ALEXANDER BLAIR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:BLAIR
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4338 REDWOOD AVE
Mailing Address - Street 2:309
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7648
Mailing Address - Country:US
Mailing Address - Phone:310-277-2464
Mailing Address - Fax:310-574-3201
Practice Address - Street 1:10350 SANTA MONICA BLVD
Practice Address - Street 2:310
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5055
Practice Address - Country:US
Practice Address - Phone:310-277-2464
Practice Address - Fax:310-574-3201
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist