MEDICARE: MRS. ROCIO LIMON GRACIANO LCSW

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	1041C0700X	Clinical Social Worker	LCS 20871	CA

General Provider Information

NPI Number	:	1114022852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROCIO LIMON GRACIANO LCSW

Provider Business Mailing Address
First Line	:	2420 FIDELIDAD DR
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-4809
Country	:	US
Telephone Number	:	626-590-7661
Fax Number	:	626-369-7052

Provider Business Practice Location Address
First Line	:	4765 E 4TH ST
Second Line	:	RM 720
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1846
Country	:	US
Telephone Number	:	323-266-7421
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	02/02/2010

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