Provider Demographics
NPI:1245562990
Name:TAYLOR, RENATA MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:RENATA
Middle Name:MICHELLE
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:PO BOX 1384
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-1384
Mailing Address - Country:US
Mailing Address - Phone:713-865-1944
Mailing Address - Fax:
Practice Address - Street 1:845 DAVIS
Practice Address - Street 2:
Practice Address - City:ARCOLA
Practice Address - State:TX
Practice Address - Zip Code:77583-2005
Practice Address - Country:US
Practice Address - Phone:713-865-1944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator