Provider Demographics
NPI:1740318732
Name:GRAHAM, KRISTJANA DIANNE (NCTMB)
Entity type:Individual
Prefix:MS
First Name:KRISTJANA
Middle Name:DIANNE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 WARNER AVE SPC 47
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-8004
Mailing Address - Country:US
Mailing Address - Phone:714-785-0885
Mailing Address - Fax:
Practice Address - Street 1:16511 GOLDENWEST ST STE C
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-4484
Practice Address - Country:US
Practice Address - Phone:714-785-0885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist