Healthcare Provider Details

I. General information

NPI: 1821504002
Provider Name (Legal Business Name): RHONDA TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2017
Last Update Date: 11/23/2023
Certification Date: 11/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8703 LA TIJERA BLVD STE 201
LOS ANGELES CA
90045
US

IV. Provider business mailing address

528 PALISADES DR # 306
PACIFIC PALISADES CA
90272-2844
US

V. Phone/Fax

Practice location:
  • Phone: 310-218-7194
  • Fax:
Mailing address:
  • Phone: 310-218-7194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95028134
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number103914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: