MEDICARE: LEONDRA LIN GRAVES OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1184550022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONDRA LIN GRAVES OTR

Provider Business Mailing Address
First Line	:	9485 OLEMA ST
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-1342
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9485 OLEMA ST
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-1342
Country	:	US
Telephone Number	:	626-264-7365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2026
Last Update Date	:	06/19/2026

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Directions to “ LEONDRA LIN GRAVES OTR” Practice Location

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