MEDICARE: MELISSA GRANADOS

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	:	1093380628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA GRANADOS

Provider Business Mailing Address
First Line	:	4401 CRENSHAW BLVD STE 215
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-1200
Country	:	US
Telephone Number	:	323-291-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 LAKES DR
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-2900
Country	:	US
Telephone Number	:	888-428-3223
Fax Number	:	323-866-1881

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

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	07/24/2023

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Directions to “ MELISSA GRANADOS ” Practice Location

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