Provider Demographics
NPI:1659605889
Name:GRAF, ANGELA (RNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GRAF
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 MONTE VISTA AVE
Mailing Address - Street 2:UNIT F
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5407
Mailing Address - Country:US
Mailing Address - Phone:951-334-9613
Mailing Address - Fax:
Practice Address - Street 1:2646 DUPONT DR
Practice Address - Street 2:SUITE 250
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-8887
Practice Address - Country:US
Practice Address - Phone:949-261-2981
Practice Address - Fax:949-261-8292
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571138163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0150193OtherMEDI-CAL