Provider Demographics
NPI:1265875975
Name:TAYLOR, ERICA J (IMF)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8255 VINEYARD AVE APT 800E
Mailing Address - Street 2:#800-E
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7177
Mailing Address - Country:US
Mailing Address - Phone:909-476-9166
Mailing Address - Fax:
Practice Address - Street 1:14652 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5333
Practice Address - Country:US
Practice Address - Phone:626-430-6197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 73739106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist