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General NPI Number Information
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NPI Number | 1225681745
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Entity Type | Individual
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Provider Name | TARA GRAYSON
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Gender | Female
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 7301 TOPANGA CANYON BLVD STE 330
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City | CANOGA PARK
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State | CA
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Zip | 91303-1357
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Country | US
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Telephone | 844-968-6363
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Fax |
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Provider Business Mailing Address
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Address Line | 1178 SHAFER ST
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City | SEASIDE
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State | CA
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Zip | 93955-5937
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Country | US
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Telephone | 831-392-6909
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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