Provider Demographics
NPI:1659413862
Name:TAYLOR, SIMONE ANNE (MED, PPS)
Entity Type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:ANNE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MED, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 G ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1829
Mailing Address - Country:US
Mailing Address - Phone:707-269-9590
Mailing Address - Fax:707-444-8012
Practice Address - Street 1:2413 2ND ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0811
Practice Address - Country:US
Practice Address - Phone:707-269-9590
Practice Address - Fax:707-444-8012
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator