Provider Demographics
NPI:1710793252
Name:WILLIGROD, TAYLAR (LAC)
Entity type:Individual
Prefix:
First Name:TAYLAR
Middle Name:
Last Name:WILLIGROD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 OLD SAN JOSE RD
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-9458
Mailing Address - Country:US
Mailing Address - Phone:831-331-9888
Mailing Address - Fax:
Practice Address - Street 1:1301 OLD SAN JOSE RD
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-9458
Practice Address - Country:US
Practice Address - Phone:831-331-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20217171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist