Healthcare Provider Details

I. General information

NPI: 1922894468
Provider Name (Legal Business Name): AMBER CORINNE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 N BLACKSTONE AVE
FRESNO CA
93726-3808
US

IV. Provider business mailing address

4141 N BLACKSTONE AVE
FRESNO CA
93726-3808
US

V. Phone/Fax

Practice location:
  • Phone: 559-579-1744
  • Fax:
Mailing address:
  • Phone: 559-579-1744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-PGNXWO
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: