Provider Demographics
NPI:1750535498
Name:GRAHAM, PAMELA MARGARET (LAC ,)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:MARGARET
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LAC ,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4323
Mailing Address - Country:US
Mailing Address - Phone:714-642-6217
Mailing Address - Fax:562-394-0593
Practice Address - Street 1:1700 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6254
Practice Address - Country:US
Practice Address - Phone:714-642-6197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA11167171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist