Healthcare Provider Details

I. General information

NPI: 1952902058
Provider Name (Legal Business Name): RYAN PAUL TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RYAN P TAYLOR PA-S

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 08/02/2022
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 E HERNDON AVE
FRESNO CA
93720-3391
US

IV. Provider business mailing address

2623 YORBA LINDA BLVD APT 222
FULLERTON CA
92831-1613
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-5200
  • Fax:
Mailing address:
  • Phone: 619-370-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number60550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: