Individual
TAYLOR NICOLE HANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1020 S ARROYO PKWY, PASADENA, CA 91105-3911
(626) 403-2794
Mailing address
5212 WILD LIFE CT, FONTANA, CA 92336-0406
(909) 816-5208
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
41404
CA
Other
Enumeration date
11/04/2019
Last updated
11/04/2019
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