Healthcare Provider Details

I. General information

NPI: 1245684844
Provider Name (Legal Business Name): RICHARD H GRAVES DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 CHERRY AVE
LONG BEACH CA
90802-3848
US

IV. Provider business mailing address

304 CHERRY AVE
LONG BEACH CA
90802-3848
US

V. Phone/Fax

Practice location:
  • Phone: 562-433-0478
  • Fax: 562-438-3690
Mailing address:
  • Phone: 562-433-0478
  • Fax: 562-438-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3954
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD HENRY GRAVES III
Title or Position: PRESIDENT
Credential: DPM
Phone: 562-433-0478