Healthcare Provider Details

I. General information

NPI: 1780227892
Provider Name (Legal Business Name): MISS DRYONNA NASHEA GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43909 30TH ST W
LANCASTER CA
93536-5843
US

IV. Provider business mailing address

43909 30TH ST W
LANCASTER CA
93536-5843
US

V. Phone/Fax

Practice location:
  • Phone: 661-860-5088
  • Fax:
Mailing address:
  • Phone: 661-860-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License NumberF7893816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: