Provider Demographics
NPI:1750968343
Name:TAYLOR, RELESHYA G (CEO)
Entity type:Individual
Prefix:MRS
First Name:RELESHYA
Middle Name:G
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10415 W PAYSON RD
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-8769
Mailing Address - Country:US
Mailing Address - Phone:623-414-6085
Mailing Address - Fax:
Practice Address - Street 1:10415 W PAYSON RD
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-8769
Practice Address - Country:US
Practice Address - Phone:623-414-6085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86-1728534OtherDEPARTMENT OF TREASURY