Healthcare Provider Details

I. General information

NPI: 1851236269
Provider Name (Legal Business Name): TAYLOR NICOLE CHESSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16888 MAILE LN
MORENO VALLEY CA
92551-2581
US

IV. Provider business mailing address

16888 MAILE LN
MORENO VALLEY CA
92551-2581
US

V. Phone/Fax

Practice location:
  • Phone: 323-434-7760
  • Fax:
Mailing address:
  • Phone: 323-434-7762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberF4500033
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberF4500033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: