Healthcare Provider Details

I. General information

NPI: 1548773161
Provider Name (Legal Business Name): JANET GRAGEOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8755 AERO DR STE 230
SAN DIEGO CA
92123-1750
US

IV. Provider business mailing address

8755 AERO DR STE 230
SAN DIEGO CA
92123-1750
US

V. Phone/Fax

Practice location:
  • Phone: 858-256-2180
  • Fax: 619-528-4625
Mailing address:
  • Phone: 858-256-2180
  • Fax: 619-528-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: