Healthcare Provider Details

I. General information

NPI: 1366324881
Provider Name (Legal Business Name): TAYLOR KRISTINE URETA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 OLIVE ST UNIT 301
SAN LUIS OBISPO CA
93405-2477
US

IV. Provider business mailing address

1131 OLIVE ST UNIT 301
SAN LUIS OBISPO CA
93405-2477
US

V. Phone/Fax

Practice location:
  • Phone: 916-990-3595
  • Fax: 916-990-3595
Mailing address:
  • Phone: 916-990-3595
  • Fax: 916-990-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: