Provider Demographics
NPI:1932526811
Name:TAYLOR, STEPHANIE NICOLE (RD)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:TAYLOR
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 1:6028 ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3717
Mailing Address - Country:US
Mailing Address - Phone:951-840-5552
Mailing Address - Fax:
Practice Address - Street 1:7887 MISSION GROVE PKWY S STE B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5055
Practice Address - Country:US
Practice Address - Phone:951-284-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA964551133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered