Healthcare Provider Details

I. General information

NPI: 1326768821
Provider Name (Legal Business Name): JOHN F GRAUCH MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

696 HAMPSHIRE RD STE 100
WESTLAKE VILLAGE CA
91361-4456
US

IV. Provider business mailing address

PO BOX 7001
TARZANA CA
91357-7001
US

V. Phone/Fax

Practice location:
  • Phone: 805-413-7920
  • Fax: 805-413-7921
Mailing address:
  • Phone: 818-888-7815
  • Fax: 818-715-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN F. GRAUCH
Title or Position: PRESIDENT
Credential: M. D.
Phone: 805-206-6050