Provider Demographics
NPI:1669530853
Name:GRAJEDA, OSCAR JAVIER (BA)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:JAVIER
Last Name:GRAJEDA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 N TEXAS ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-1290
Mailing Address - Country:US
Mailing Address - Phone:707-429-4440
Mailing Address - Fax:
Practice Address - Street 1:2750 N TEXAS ST
Practice Address - Street 2:SUITE 430
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-1290
Practice Address - Country:US
Practice Address - Phone:707-429-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health