Provider Demographics
NPI:1730763111
Name:TAYLOR, LISA M
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FIT2B BREAST &
Other - Middle Name:BODY
Other - Last Name:THERMOGRAPHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:THERMOGRAPHER
Mailing Address - Street 1:16 ANDREAS CIR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-1229
Mailing Address - Country:US
Mailing Address - Phone:562-841-1183
Mailing Address - Fax:
Practice Address - Street 1:250 BEL MARIN KEYS BLVD STE D1
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-5709
Practice Address - Country:US
Practice Address - Phone:562-841-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician