Healthcare Provider Details

I. General information

NPI: 1144670324
Provider Name (Legal Business Name): SHANTE MARIE TAYLOR M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N NORMA ST SUITE 133
RIDGECREST CA
93555-3613
US

IV. Provider business mailing address

29325 KIMBERLINA ROAD
WASCO CA
93280
US

V. Phone/Fax

Practice location:
  • Phone: 760-499-7406
  • Fax:
Mailing address:
  • Phone: 661-758-4029
  • Fax: 661-758-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number63398
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: