Healthcare Provider Details

I. General information

NPI: 1417341330
Provider Name (Legal Business Name): ANTHONY GRAVES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 GOLDEN HILL RD STE 102
PASO ROBLES CA
93446-7048
US

IV. Provider business mailing address

PO BOX 3341
PASO ROBLES CA
93447-3341
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-2900
  • Fax: 805-434-2928
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: