Provider Demographics
NPI:1841332103
Name:MULHERIN-TAYLOR, DIANA (MD)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:MULHERIN-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 1:2114 MALCOLM AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6306
Mailing Address - Country:US
Mailing Address - Phone:310-575-3100
Mailing Address - Fax:310-575-3100
Practice Address - Street 1:2143 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE #300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5733
Practice Address - Country:US
Practice Address - Phone:310-575-3100
Practice Address - Fax:310-575-3102
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine