Provider Demographics
NPI:1679186506
Name:TAITANO, DANTE (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:
Last Name:TAITANO
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 WILSHIRE BLVD STE 170-16
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3519
Mailing Address - Country:US
Mailing Address - Phone:213-441-6780
Mailing Address - Fax:
Practice Address - Street 1:4221 WILSHIRE BLVD STE 170-16
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3519
Practice Address - Country:US
Practice Address - Phone:213-441-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170155888103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool