Healthcare Provider Details

I. General information

NPI: 1639067689
Provider Name (Legal Business Name): DAVID GRAHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 MOTOR AVE
LOS ANGELES CA
90034-4806
US

IV. Provider business mailing address

2507 S BRONSON AVE APT 410
LOS ANGELES CA
90018-1976
US

V. Phone/Fax

Practice location:
  • Phone: 310-836-8900
  • Fax:
Mailing address:
  • Phone: 661-733-1056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3374
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XH1300X
TaxonomyHuman Factors Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: