Provider Demographics
NPI:1043557986
Name:TAYLOR, CATHERINE JENNY
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JENNY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15624 CARAVELLE AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4139
Mailing Address - Country:US
Mailing Address - Phone:909-239-2540
Mailing Address - Fax:
Practice Address - Street 1:15624 CARAVELLE AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4139
Practice Address - Country:US
Practice Address - Phone:909-239-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor