Provider Demographics
NPI:1750720975
Name:GRAVES, DAPHNE
Entity type:Individual
Prefix:MISS
First Name:DAPHNE
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6618 SEVILLE AVE
Mailing Address - Street 2:APARTMENT 109
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4866
Mailing Address - Country:US
Mailing Address - Phone:323-835-6266
Mailing Address - Fax:
Practice Address - Street 1:2241 W WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90810-3652
Practice Address - Country:US
Practice Address - Phone:562-388-8183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner