Provider Demographics
NPI:1770222630
Name:GRACIANO, TAYLOR CLARICE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CLARICE
Last Name:GRACIANO
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 1:4743 N MIDSITE AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-2717
Mailing Address - Country:US
Mailing Address - Phone:626-622-0690
Mailing Address - Fax:
Practice Address - Street 1:4743 N MIDSITE AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-2717
Practice Address - Country:US
Practice Address - Phone:626-622-0690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician