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General NPI Number Information
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NPI Number | 1811711286
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Entity Type | Individual
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Provider Name | AARON GRADDY
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Gender | Male
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 2560 N PERRIS BLVD STE N1
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City | PERRIS
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State | CA
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Zip | 92571-3251
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Country | US
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Telephone | 951-940-6755
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Fax |
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Provider Business Mailing Address
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Address Line | 12557 PENSKE ST
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City | MORENO VALLEY
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State | CA
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Zip | 92553-5208
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Country | US
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Telephone | 951-432-6589
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | CA
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