Healthcare Provider Details

I. General information

NPI: 1508270513
Provider Name (Legal Business Name): KATIA TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 SOUTHERN SKY
SAN ANTONIO TX
78222-3457
US

IV. Provider business mailing address

3911 SOUTHERN SKY
SAN ANTONIO TX
78222-3457
US

V. Phone/Fax

Practice location:
  • Phone: 210-835-8853
  • Fax:
Mailing address:
  • Phone: 210-835-8853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number37558410
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA0891200
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: