Healthcare Provider Details

I. General information

NPI: 1104632785
Provider Name (Legal Business Name): TAYLOR REANN RICHARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 E PALMDALE BLVD STE 14
PALMDALE CA
93550-2019
US

IV. Provider business mailing address

1545 HOTEL CIR S STE 301
SAN DIEGO CA
92108-3400
US

V. Phone/Fax

Practice location:
  • Phone: 661-228-0567
  • Fax: 619-241-2678
Mailing address:
  • Phone: 661-618-6361
  • Fax: 619-241-2678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: