Provider Demographics
NPI:1073106316
Name:CARRANZA, TAYLOR MITSUKO MAYEDA
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MITSUKO MAYEDA
Last Name:CARRANZA
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 1:15340 DEVONSHIRE ST STE 7
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2760
Mailing Address - Country:US
Mailing Address - Phone:323-538-0975
Mailing Address - Fax:818-484-4084
Practice Address - Street 1:15340 DEVONSHIRE ST STE 7
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2760
Practice Address - Country:US
Practice Address - Phone:323-538-0975
Practice Address - Fax:818-484-4084
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122346106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist