Healthcare Provider Details

I. General information

NPI: 1316927569
Provider Name (Legal Business Name): REBECCA SUE GRAUL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4647 ZION AVE
SAN DIEGO CA
92120-2507
US

IV. Provider business mailing address

930 CAMINO DE LA REINA
SAN DIEGO CA
92108-3254
US

V. Phone/Fax

Practice location:
  • Phone: 619-528-5288
  • Fax:
Mailing address:
  • Phone: 619-255-9368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number340829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: