Provider Demographics
NPI:1174993604
Name:TAYLOR ROSE, ARLENE ARETHA (MSN, PMHNP-BC, CCRN)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:ARETHA
Last Name:TAYLOR ROSE
Suffix:
Gender:
Credentials:MSN, PMHNP-BC, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N SAN VICENTE BLVD STE 253
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2329
Mailing Address - Country:US
Mailing Address - Phone:424-209-4500
Mailing Address - Fax:818-450-0611
Practice Address - Street 1:8453 FIR DR APT D
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4160
Practice Address - Country:US
Practice Address - Phone:818-473-0156
Practice Address - Fax:641-207-4228
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-27
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78207163W00000X, 2083P0901X
CA716641163WC0200X
261QM0801X, 261QM0855X, 261QP2300X
CA95006428363L00000X, 363LP0808X
CA1099329363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner