Healthcare Provider Details

I. General information

NPI: 1013576081
Provider Name (Legal Business Name): ANTHONY GRACIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 KINGS COUNTY DR STE 104&106
HANFORD CA
93230-3579
US

IV. Provider business mailing address

P.O. BOX 788
CORCORAN CA
93212
US

V. Phone/Fax

Practice location:
  • Phone: 559-754-3128
  • Fax:
Mailing address:
  • Phone: 559-362-9958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberASW84573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: