Basic Information
| Provider Information | |||||||||
| NPI: | 1447865845 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE GRAAF-GARCIA | ||||||||
| FirstName: | LAUREL | ||||||||
| MiddleName: | PATRICIA | ||||||||
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| Credential: | CMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 243 W WILSHIRE AVE | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928321825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142670201 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1202 BRISTOL ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926268605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144249001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2020 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 71378 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.