Healthcare Provider Details

I. General information

NPI: 1548939028
Provider Name (Legal Business Name): NAOMI GRAHAM L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22824 INDUSTRIAL PL
GRASS VALLEY CA
95949-6326
US

IV. Provider business mailing address

PO BOX 2955
GRASS VALLEY CA
95945-2955
US

V. Phone/Fax

Practice location:
  • Phone: 707-849-4834
  • Fax:
Mailing address:
  • Phone: 707-849-4834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: