Provider Demographics
NPI:1639800675
Name:GRAVES, PAULA MIRANDA
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MIRANDA
Last Name:GRAVES
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 1:15116 MESA DR APT 221
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-2395
Mailing Address - Country:US
Mailing Address - Phone:870-575-3291
Mailing Address - Fax:
Practice Address - Street 1:15116 MESA DR APT 221
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-2395
Practice Address - Country:US
Practice Address - Phone:870-575-3291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy