MEDICARE: JOHN JEFFREY GRAMA M.A.

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	231H00000X	Audiologist	AU 362	CA
2	237600000X	Audiologist-Hearing Aid Fitter	HA 1056	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902971757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JEFFREY GRAMA M.A.

Provider Business Mailing Address
First Line	:	7080 HOLLYWOOD BLVD
Second Line	:	SUITE 814
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6935
Country	:	US
Telephone Number	:	323-463-7109
Fax Number	:	323-463-7707

Provider Business Practice Location Address
First Line	:	7080 HOLLYWOOD BLVD
Second Line	:	SUITE 814
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6935
Country	:	US
Telephone Number	:	323-463-7109
Fax Number	:	323-463-7707

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	05/09/2012

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