Healthcare Provider Details

I. General information

NPI: 1689930893
Provider Name (Legal Business Name): MRS. MYESHA BERNICE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 W SHAW AVE STE 101
FRESNO CA
93711-3234
US

IV. Provider business mailing address

1694 S DELNO AVE APT 104
FRESNO CA
93706-2809
US

V. Phone/Fax

Practice location:
  • Phone: 559-275-1784
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: