Healthcare Provider Details

I. General information

NPI: 1912490459
Provider Name (Legal Business Name): TAYLOR PAGANO ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2018
Last Update Date: 06/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 W BROAD ST STE 107
RICHMOND VA
23220-2022
US

IV. Provider business mailing address

2201 W BROAD ST STE 107
RICHMOND VA
23220-2022
US

V. Phone/Fax

Practice location:
  • Phone: 804-469-0959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number16-1587
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: