Healthcare Provider Details

I. General information

NPI: 1306322367
Provider Name (Legal Business Name): GINA MICHELLE TAYLOR BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6830 PIEDMONT ST, CHINO, CA, 91710
CHINO CA
91710
US

IV. Provider business mailing address

6830 PIEDMONT ST
CHINO CA
91710-1314
US

V. Phone/Fax

Practice location:
  • Phone: 909-680-0189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-23427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: