Healthcare Provider Details

I. General information

NPI: 1306862040
Provider Name (Legal Business Name): GRETCHEN DENISE GRAVES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 GLADSTONE DR SUITE 2
PITTSBURG CA
94565-5125
US

IV. Provider business mailing address

2260 GLADSTONE DR SUITE 2
PITTSBURG CA
94565-5125
US

V. Phone/Fax

Practice location:
  • Phone: 925-427-0391
  • Fax: 925-427-6797
Mailing address:
  • Phone: 925-427-0391
  • Fax: 925-427-6797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG46185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: