Provider Demographics
NPI:1922057918
Name:GRABER, EMMA WOODHOUSE (MD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:WOODHOUSE
Last Name:GRABER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:SALLY
Other - Last Name:WOODHOUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4097 SAPPHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3638
Mailing Address - Country:US
Mailing Address - Phone:818-461-9890
Mailing Address - Fax:661-729-7110
Practice Address - Street 1:43112 15TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-6219
Practice Address - Country:US
Practice Address - Phone:661-729-7170
Practice Address - Fax:661-729-7110
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85064174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH85632Medicare UPIN