Provider Demographics
NPI:1083173728
Name:TAYLOR, FIDEL MURUA
Entity Type:Individual
Prefix:MR
First Name:FIDEL
Middle Name:MURUA
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 CARLSBAD ST SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-6152
Mailing Address - Country:US
Mailing Address - Phone:515-302-5214
Mailing Address - Fax:
Practice Address - Street 1:2412 CARLSBAD ST SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-6152
Practice Address - Country:US
Practice Address - Phone:515-302-5214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAFT00163752278P4000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P4000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPatient Transport