Healthcare Provider Details

I. General information

NPI: 1225966187
Provider Name (Legal Business Name): GABRIELLE LEA GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELI LEA GRAHAM

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W TOWN AND COUNTRY RD STE 1225
ORANGE CA
92868-4638
US

IV. Provider business mailing address

1231 S SUNBURST WAY APT A
ANAHEIM CA
92806-5431
US

V. Phone/Fax

Practice location:
  • Phone: 657-565-3259
  • Fax:
Mailing address:
  • Phone: 714-900-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: