MEDICARE: IFAH GRADY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-24-75367	CA

General Provider Information

NPI Number	:	1497478234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IFAH GRADY

Provider Business Mailing Address
First Line	:	10985 PACIFIC POINT PL UNIT 1203
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2088
Country	:	US
Telephone Number	:	858-253-0809
Fax Number	:

Provider Business Practice Location Address
First Line	:	10985 PACIFIC POINT PL UNIT 1203
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2088
Country	:	US
Telephone Number	:	858-253-0809
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2022
Last Update Date	:	02/11/2025

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Directions to “ IFAH GRADY ” Practice Location

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