Provider Demographics
NPI:1710565940
Name:CRIOLLO, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CRIOLLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12750 VENTURA BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2433
Mailing Address - Country:US
Mailing Address - Phone:818-423-2215
Mailing Address - Fax:
Practice Address - Street 1:5344 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY VLG
Practice Address - State:CA
Practice Address - Zip Code:91607-2712
Practice Address - Country:US
Practice Address - Phone:818-423-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician