Provider Demographics
NPI:1881299196
Name:LLANOS, PRISCILLA MARIE (MS)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:MARIE
Last Name:LLANOS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 CLARADAY ST APT 12
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6525
Mailing Address - Country:US
Mailing Address - Phone:626-234-1799
Mailing Address - Fax:
Practice Address - Street 1:50 N HILL AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1949
Practice Address - Country:US
Practice Address - Phone:714-672-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst