Provider Demographics
NPI:1982197174
Name:TRINH TAYLOR CORP
Entity Type:Organization
Organization Name:TRINH TAYLOR CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THAO
Authorized Official - Middle Name:T
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:818-723-5435
Mailing Address - Street 1:24342 VISTA HILLS DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3130
Mailing Address - Country:US
Mailing Address - Phone:818-723-5435
Mailing Address - Fax:818-858-1870
Practice Address - Street 1:16055 VENTURA BLVD STE 1112
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2612
Practice Address - Country:US
Practice Address - Phone:818-723-5435
Practice Address - Fax:818-858-1870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24474103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1768409791Medicaid