Healthcare Provider Details

I. General information

NPI: 1922136597
Provider Name (Legal Business Name): JOELLEN JEAN GRAULTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 ARNOLD DR SUITE #160
MARTINEZ CA
94553-6537
US

IV. Provider business mailing address

405 RED OAK AVENUE #305
ALBANY CA
94706
US

V. Phone/Fax

Practice location:
  • Phone: 925-229-5400
  • Fax:
Mailing address:
  • Phone: 916-276-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: