Provider Demographics
NPI:1104632785
Name:RICHARDS, TAYLOR REANN
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:REANN
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 HOTEL CIR S STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3400
Mailing Address - Country:US
Mailing Address - Phone:661-618-6361
Mailing Address - Fax:619-241-2678
Practice Address - Street 1:1311 E PALMDALE BLVD STE 14
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-2019
Practice Address - Country:US
Practice Address - Phone:661-228-0567
Practice Address - Fax:619-241-2678
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2025-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator