Provider Demographics
NPI:1639932239
Name:TAYLOR, HEATHER (MS, RD, CNSC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, RD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LAUREL CREEK LN
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4472
Mailing Address - Country:US
Mailing Address - Phone:949-606-4235
Mailing Address - Fax:
Practice Address - Street 1:30 LAUREL CREEK LN
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4472
Practice Address - Country:US
Practice Address - Phone:949-606-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86156200133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered