Provider Demographics
NPI:1194418566
Name:ARROYO-TABIN, TAYLOR TERESA
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:TERESA
Last Name:ARROYO-TABIN
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 1:9823 KIKA CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-5058
Mailing Address - Country:US
Mailing Address - Phone:619-871-6374
Mailing Address - Fax:
Practice Address - Street 1:831 11TH ST
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-2827
Practice Address - Country:US
Practice Address - Phone:619-871-6838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA011498957OtherDRIVER LICENSE