MEDICARE: CECILIA GRANDENO-QUINTANAR

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
2	103K00000X	Behavior Analyst	1-21-55807	CA

General Provider Information

NPI Number	:	1427517713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILIA GRANDENO-QUINTANAR

Provider Business Mailing Address
First Line	:	3700 W MINERAL KING AVE
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93291-5531
Country	:	US
Telephone Number	:	559-825-8455
Fax Number	:	559-334-3480

Provider Business Practice Location Address
First Line	:	3700 W MINERAL KING AVE
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93291-5531
Country	:	US
Telephone Number	:	559-825-8455
Fax Number	:	559-334-3480

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

Provider Enumeration Date	:	03/15/2019
Last Update Date	:	09/13/2022

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