Provider Demographics
NPI:1942235668
Name:TAYLOR, VANESSA ML (DPM)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:ML
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:15944 LOS SERRANOS COUNTRY CLUB DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3254
Mailing Address - Country:US
Mailing Address - Phone:909-287-0677
Mailing Address - Fax:909-631-2919
Practice Address - Street 1:15944 LOS SERRANOS COUNTRY CLUB DR STE 130
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-3254
Practice Address - Country:US
Practice Address - Phone:909-287-0677
Practice Address - Fax:909-631-2919
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4258213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E42580Medicaid
CAE4258OtherSTATE LICENSE
CA5065080001OtherNORDIAN ID
CA81-0644182OtherTAX ID
CA834623340OtherTAX ID
CA000E42580Medicaid