Provider Demographics
NPI:1700254463
Name:TAYLOR, BIANCA KATALINA CRYSTAL
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:KATALINA CRYSTAL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:KATALINA CRYSTAL
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4075 DRACO DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436
Mailing Address - Country:US
Mailing Address - Phone:818-993-9311
Mailing Address - Fax:
Practice Address - Street 1:4075 DRACO DR
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-1835
Practice Address - Country:US
Practice Address - Phone:805-291-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2022-05-24
Deactivation Date:2022-04-05
Deactivation Code:
Reactivation Date:2022-05-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical