MEDICARE: ADRIENNE CARINO

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

General Provider Information

NPI Number	:	1083483614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE CARINO

Provider Business Mailing Address
First Line	:	2080 N TUSTIN AVE STE B
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-7875
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11400 W OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1550
Country	:	US
Telephone Number	:	855-581-0100
Fax Number	:

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

Provider Enumeration Date	:	12/22/2023
Last Update Date	:	12/22/2023

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Directions to “ ADRIENNE CARINO ” Practice Location

Language	Start Address	Practice Location

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