Provider Demographics
NPI:1710619085
Name:GRAFF, ALYSSA EDEN
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:EDEN
Last Name:GRAFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:EDEN
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1201 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-2909
Mailing Address - Country:US
Mailing Address - Phone:956-665-7049
Mailing Address - Fax:
Practice Address - Street 1:107 BOWLING GREEN DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2418
Practice Address - Country:US
Practice Address - Phone:918-833-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program