Provider Demographics
NPI:1215211164
Name:TAYLOR-MADE MOBILE HEALTH
Entity Type:Organization
Organization Name:TAYLOR-MADE MOBILE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARILA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:915-599-9844
Mailing Address - Street 1:8010 N LOOP DR
Mailing Address - Street 2:SUITE 200-A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-3226
Mailing Address - Country:US
Mailing Address - Phone:915-599-9844
Mailing Address - Fax:915-581-7721
Practice Address - Street 1:8010 N LOOP DR
Practice Address - Street 2:SUITE 200-A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-3226
Practice Address - Country:US
Practice Address - Phone:915-599-9844
Practice Address - Fax:915-581-7721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX551784363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX70143524OtherDPS CERT #