Provider Demographics
NPI:1134990419
Name:HERNANDEZ, TAYLOR JANAE (CTRS)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:JANAE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:JANAE
Other - Last Name:LUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1050 S 173RD AVE APT 56
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-6421
Mailing Address - Country:US
Mailing Address - Phone:602-330-8754
Mailing Address - Fax:
Practice Address - Street 1:650 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1839
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist