Healthcare Provider Details

I. General information

NPI: 1881299196
Provider Name (Legal Business Name): PRISCILLA MARIE LLANOS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N HILL AVE
PASADENA CA
91106-1949
US

IV. Provider business mailing address

627 CLARADAY ST APT 12
GLENDORA CA
91740-6525
US

V. Phone/Fax

Practice location:
  • Phone: 714-672-0866
  • Fax:
Mailing address:
  • Phone: 626-234-1799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: