Provider Demographics
NPI:1801145818
Name:EYHERABIDE, GRACIELA II
Entity type:Individual
Prefix:MRS
First Name:GRACIELA
Middle Name:
Last Name:EYHERABIDE
Suffix:II
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 1:820 ALASKA WAY
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060-3975
Mailing Address - Country:US
Mailing Address - Phone:775-727-3685
Mailing Address - Fax:
Practice Address - Street 1:820 ALASKA WAY
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-3975
Practice Address - Country:US
Practice Address - Phone:775-727-3685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner