MEDICARE: TAYLOR-MADE MOBILE HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	551784	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	70143524	OTHER	TX	DPS CERT #

General Provider Information

NPI Number	:	1215211164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAYLOR-MADE MOBILE HEALTH

Provider Business Mailing Address
First Line	:	8010 N LOOP DR
Second Line	:	SUITE 200-A
City	:	EL PASO
State	:	TX
Zip	:	79915-3226
Country	:	US
Telephone Number	:	915-599-9844
Fax Number	:	915-581-7721

Provider Business Practice Location Address
First Line	:	8010 N LOOP DR
Second Line	:	SUITE 200-A
City	:	EL PASO
State	:	TX
Zip	:	79915-3226
Country	:	US
Telephone Number	:	915-599-9844
Fax Number	:	915-581-7721

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARILA TAYLOR
Credential	:	FNP
Telephone Number	:	915-599-9844

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	10/10/2011

Similar Medicare Providers

1124225818 — MARILA TAYLOR FNP-BC
Practice Location Address:

8010 N LOOP DR STE 200-A
EL PASO, TX
79915-3226

Practice Phone: 915-599-9844
Practice Fax: 915-581-7721

1902036155 — APRIL LEMER FROWNER PA
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1023403078 — DANIEL O MCAFFEE DPM
Practice Location Address:

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1215706502 — PROF. BELINDA ACUNA LPC
Practice Location Address:

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Practice Location Address:

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1659256006 — JENNIFER MARIE SEEGARS APRN
Practice Location Address:

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