Provider Demographics
NPI:1114530615
Name:TAYLOR, RAMONA LANDRY (MA)
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:LANDRY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:RAMONA
Other - Middle Name:LANDRY
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 1529
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-1529
Mailing Address - Country:US
Mailing Address - Phone:808-763-7659
Mailing Address - Fax:
Practice Address - Street 1:1916 ORANGE TREE LN STE 450C
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4520
Practice Address - Country:US
Practice Address - Phone:808-763-7659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97652106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist