Provider Demographics
NPI:1669871695
Name:CARROLL, TAYLOR LEIGH (RD)
Entity type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:LEIGH
Last Name:CARROLL
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 1:1840 PARK NEWPORT APT 314
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5057
Mailing Address - Country:US
Mailing Address - Phone:949-258-2524
Mailing Address - Fax:
Practice Address - Street 1:1840 PARK NEWPORT APT 314
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5057
Practice Address - Country:US
Practice Address - Phone:949-258-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1096080133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered