Healthcare Provider Details

I. General information

NPI: 1922459254
Provider Name (Legal Business Name): AMBER GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1947 HASS CT
SANTA PAULA CA
93060-8027
US

IV. Provider business mailing address

3300 TAFFRAIL LN
OXNARD CA
93035-1682
US

V. Phone/Fax

Practice location:
  • Phone: 805-832-8777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number262692
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95216086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: