Provider Demographics
NPI:1538325444
Name:TAYLOR, LISA M
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
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 1:9150 IMPERIAL HWY
Mailing Address - Street 2:ROOM P-31
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2835
Mailing Address - Country:US
Mailing Address - Phone:562-940-3694
Mailing Address - Fax:562-658-7425
Practice Address - Street 1:14414 DELANO ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2703
Practice Address - Country:US
Practice Address - Phone:818-374-2001
Practice Address - Fax:818-989-8903
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator