Provider Demographics
NPI:1699386136
Name:TAYLOR, LORI (RD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:RIO OSO
Mailing Address - State:CA
Mailing Address - Zip Code:95674-9611
Mailing Address - Country:US
Mailing Address - Phone:916-208-4846
Mailing Address - Fax:
Practice Address - Street 1:978 4TH AVE
Practice Address - Street 2:
Practice Address - City:RIO OSO
Practice Address - State:CA
Practice Address - Zip Code:95674-9611
Practice Address - Country:US
Practice Address - Phone:916-208-4846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86155783133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered