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General NPI Number Information
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NPI Number | 1629955422
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Entity Type | Individual
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Provider Name | MRS. ANDREA GRAVES
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Gender | Female
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 2351 CARDINAL LANE ANNEX N
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City | SAN DIEGO
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State | CA
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Zip | 92123-3743
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Country | US
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Telephone | 619-540-2095
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Fax |
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Provider Business Mailing Address
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Address Line | 2711 CHAFFEE ST
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City | NATIONAL CITY
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State | CA
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Zip | 91950-7712
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Country | US
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Telephone | 619-540-2095
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | AB2599DB33
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License Number State | CA
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