Healthcare Provider Details

I. General information

NPI: 1134048507
Provider Name (Legal Business Name): TAYLOR WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 E GILBERT ST BLDG H
SAN BERNARDINO CA
92415-1003
US

IV. Provider business mailing address

807 W 124TH ST
LOS ANGELES CA
90044-3809
US

V. Phone/Fax

Practice location:
  • Phone: 909-763-4760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN760391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: