Provider Demographics
NPI:1245282557
Name:TAYLOR, DANETTE (MD)
Entity type:Individual
Prefix:
First Name:DANETTE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 LOMITA BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5108
Mailing Address - Country:US
Mailing Address - Phone:310-784-4926
Mailing Address - Fax:310-891-6793
Practice Address - Street 1:855 MANHATTAN BEACH BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-4965
Practice Address - Country:US
Practice Address - Phone:310-939-7858
Practice Address - Fax:310-939-7842
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A671590OtherBLUE SHIELD
CAH30459Medicare UPIN
WA67159BMedicare ID - Type Unspecified