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General NPI Number Information
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NPI Number | 1730430489
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Entity Type | Individual
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Provider Name | STEVEN M DEGRAW
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Gender | Male
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 4860 VISTA BLVD SUITE 200
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City | SPARKS
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State | NV
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Zip | 89436-2863
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Country | US
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Telephone | 408-600-9317
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 51354
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City | SPARKS
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State | NV
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Zip | 89435-1354
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Country | US
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Telephone | 866-832-3015
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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