Provider Demographics
NPI:1417336371
Name:MANNING-TAYLOR, CHITISHA (CSFA)
Entity Type:Individual
Prefix:
First Name:CHITISHA
Middle Name:
Last Name:MANNING-TAYLOR
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28969 SAN BERNARD RIVER LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4139
Mailing Address - Country:US
Mailing Address - Phone:832-265-1830
Mailing Address - Fax:
Practice Address - Street 1:28969 SAN BERNARD RIVER LOOP
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4139
Practice Address - Country:US
Practice Address - Phone:832-265-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX157192246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant