Healthcare Provider Details

I. General information

NPI: 1467942425
Provider Name (Legal Business Name): JENELYN R TAYLOR LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26921 CROWN VALLEY PKWY STE 200
MISSION VIEJO CA
92691-6501
US

IV. Provider business mailing address

26921 CROWN VALLEY PKWY STE 200
MISSION VIEJO CA
92691-6501
US

V. Phone/Fax

Practice location:
  • Phone: 949-334-8288
  • Fax: 949-334-8294
Mailing address:
  • Phone: 949-334-8288
  • Fax: 949-334-8294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number283460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: