Healthcare Provider Details

I. General information

NPI: 1306057633
Provider Name (Legal Business Name): JERI LYNNE GRAEHL L.AC M.A.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 GRAPEVINE DR
OXNARD CA
93036-1578
US

IV. Provider business mailing address

2502 GRAPEVINE DR
OXNARD CA
93036-1578
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-9491
  • Fax:
Mailing address:
  • Phone: 805-981-9491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number8356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: