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 1:310 JAMES WAY STE 150
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2877
Mailing Address - Country:US
Mailing Address - Phone:805-206-3354
Mailing Address - Fax:
Practice Address - Street 1:310 JAMES WAY STE 150
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2877
Practice Address - Country:US
Practice Address - Phone:805-206-3354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2025-06-03
Deactivation Date:2022-04-05
Deactivation Code:
Reactivation Date:2022-05-10
Provider Licenses
StateLicense IDTaxonomies
CALCSW961351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical