Healthcare Provider Details

I. General information

NPI: 1750191995
Provider Name (Legal Business Name): ANGEL MARIE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40925 COUNTY CENTER DR
TEMECULA CA
92591-6054
US

IV. Provider business mailing address

40925 COUNTY CENTER DR
TEMECULA CA
92591-6054
US

V. Phone/Fax

Practice location:
  • Phone: 951-600-6360
  • Fax:
Mailing address:
  • Phone: 951-600-6360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-KEFCST
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: