Provider Demographics
NPI:1669097507
Name:SCIARRINO, BREANNA TAYLOR
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:TAYLOR
Last Name:SCIARRINO
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:PO BOX 421435
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-0435
Mailing Address - Country:US
Mailing Address - Phone:585-484-0533
Mailing Address - Fax:
Practice Address - Street 1:300 CORPORATE POINTE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-7614
Practice Address - Country:US
Practice Address - Phone:424-433-5447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402980-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health