Healthcare Provider Details

I. General information

NPI: 1760171797
Provider Name (Legal Business Name): BECKY DANIELLE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 M ST
FRESNO CA
93721-1808
US

IV. Provider business mailing address

1515 E JENSEN AVE APT 203
FRESNO CA
93706-4955
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-2700
  • Fax: 559-264-2767
Mailing address:
  • Phone: 559-273-1458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number728481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: