Basic Information
| Provider Information | |||||||||
| NPI: | 1316005309 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | GLORIA | ||||||||
| MiddleName: | C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7248 SOUTH LAND PARK DR. | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958313661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163924000 | ||||||||
| FaxNumber: | 9163927215 | ||||||||
| Practice Location | |||||||||
| Address1: | 7248 SOUTH LAND PARK DR. | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958313661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163924000 | ||||||||
| FaxNumber: | 9163922722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 09/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 171070 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA17107 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | GR0078350 | 01 | CA | MEDICAL | OTHER | MT1313852 | 01 | DEA | OTHER |