MEDICARE: TAYLOR ORAVILLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	17-33191	CA

General Provider Information

NPI Number	:	1457859134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR ORAVILLO

Provider Business Mailing Address
First Line	:	PO BOX 5157
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95352-5157
Country	:	US
Telephone Number	:	209-572-2589
Fax Number	:	209-572-1461

Provider Business Practice Location Address
First Line	:	4196 DOUGLAS BLVD
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-5904
Country	:	US
Telephone Number	:	916-489-1376
Fax Number	:	916-489-1386

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	01/16/2019

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Directions to “ TAYLOR ORAVILLO ” Practice Location

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