Provider Demographics
NPI:1770950487
Name:FRANTZ, TAYLOR (RD)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:
Last Name:FRANTZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:WELLWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1718 W COLTER ST UNIT 199
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2957
Mailing Address - Country:US
Mailing Address - Phone:805-901-3426
Mailing Address - Fax:
Practice Address - Street 1:1718 W COLTER ST UNIT 199
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2957
Practice Address - Country:US
Practice Address - Phone:805-901-3426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1100408133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered