Healthcare Provider Details

I. General information

NPI: 1669231254
Provider Name (Legal Business Name): RODNEY J TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 10/04/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 5TH PL
LAS VEGAS NV
89104-1422
US

IV. Provider business mailing address

2654 W HORIZON RIDGE PKWY # B5136
HENDERSON NV
89052-2803
US

V. Phone/Fax

Practice location:
  • Phone: 702-672-8654
  • Fax:
Mailing address:
  • Phone: 702-241-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number86-3770518
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: