Provider Demographics
NPI:1427517713
Name:GRANDENO-QUINTANAR, CECILIA
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:GRANDENO-QUINTANAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 W MINERAL KING AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5531
Mailing Address - Country:US
Mailing Address - Phone:559-825-8455
Mailing Address - Fax:559-334-3480
Practice Address - Street 1:3700 W MINERAL KING AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5531
Practice Address - Country:US
Practice Address - Phone:559-825-8455
Practice Address - Fax:559-334-3480
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA1-21-55807103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician