MEDICARE: BONITA TAYLOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	19705	CA

General Provider Information

NPI Number	:	1548515018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONITA TAYLOR

Provider Business Mailing Address
First Line	:	12792 VALLEY VIEW ST STE E
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2509
Country	:	US
Telephone Number	:	714-898-2580
Fax Number	:	714-898-2589

Provider Business Practice Location Address
First Line	:	12792 VALLEY VIEW ST STE E
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2509
Country	:	US
Telephone Number	:	714-898-2580
Fax Number	:	714-898-2589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	07/19/2012

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Directions to “ BONITA TAYLOR ” Practice Location

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