Provider Demographics
NPI:1689702847
Name:TAYLOR, CARSANDRA YVONNE (ATC)
Entity Type:Individual
Prefix:
First Name:CARSANDRA
Middle Name:YVONNE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3126 S ADRIENNE DR
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-2105
Mailing Address - Country:US
Mailing Address - Phone:626-964-0935
Mailing Address - Fax:
Practice Address - Street 1:1100 N GRAND AVE
Practice Address - Street 2:MT. SAN ANTONIO COLLEGE
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91987
Practice Address - Country:US
Practice Address - Phone:909-594-5611
Practice Address - Fax:909-468-4041
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer