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NPI Code Detail

MEDICARE: STEPHANIE REBECCA GRADY

MEDICARE: STEPHANIE REBECCA 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
1175T00000XPeer SpecialistCA

General Provider Information

NPI Number : 1821925942
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE REBECCA GRADY
Provider Business Mailing Address
First Line : 1400 N JOHNSON AVE STE 101
Second Line :
City : EL CAJON
State : CA
Zip : 92020-1651
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1400 N JOHNSON AVE STE 101
Second Line :
City : EL CAJON
State : CA
Zip : 92020-1651
Country : US
Telephone Number : 619-336-1226
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2026
Last Update Date : 05/04/2026

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Directions to “ STEPHANIE REBECCA GRADY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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