Healthcare Provider Details

I. General information

NPI: 1528211380
Provider Name (Legal Business Name): EILEEN TAYLOR R.T RPA/RA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

324 NW 107TH AVE
PEMBROKE PINES FL
33026-4068
US

V. Phone/Fax

Practice location:
  • Phone: 305-325-5916
  • Fax: 305-325-4362
Mailing address:
  • Phone: 954-993-5855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberCRT63524
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: