Healthcare Provider Details

I. General information

NPI: 1093521346
Provider Name (Legal Business Name): KRESTA GRABAU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 BROOKHURST ST STE 4300
FOUNTAIN VALLEY CA
92708-6728
US

IV. Provider business mailing address

386 N EARLHAM ST
ORANGE CA
92869-2906
US

V. Phone/Fax

Practice location:
  • Phone: 714-378-7650
  • Fax:
Mailing address:
  • Phone: 619-549-3989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number719888
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number719888
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number719888
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number719888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: