Provider Demographics
NPI:1679376503
Name:TAYLOR, LOREAL TREAJETTA (MED)
Entity type:Individual
Prefix:
First Name:LOREAL
Middle Name:TREAJETTA
Last Name:TAYLOR
Suffix:
Gender:
Credentials:MED
Other - Prefix:MS
Other - First Name:LOREAL
Other - Middle Name:TREAJETTA
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:2010 CROW CANYON PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4634
Mailing Address - Country:US
Mailing Address - Phone:209-513-6077
Mailing Address - Fax:
Practice Address - Street 1:2010 CROW CANYON PL
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4634
Practice Address - Country:US
Practice Address - Phone:209-513-6077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician