MEDICARE: PRINCE A TAYLOR

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1619717956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRINCE A TAYLOR

Provider Business Mailing Address
First Line	:	3800 DALECREST DR UNIT 2111
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-1769
Country	:	US
Telephone Number	:	725-724-7345
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 DALECREST DR UNIT 2111
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-1769
Country	:	US
Telephone Number	:	725-724-7345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2024
Last Update Date	:	05/24/2024

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Directions to “ PRINCE A TAYLOR ” Practice Location

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