Provider Demographics
NPI:1093521346
Name:GRABAU, KRESTA (RN)
Entity type:Individual
Prefix:MRS
First Name:KRESTA
Middle Name:
Last Name:GRABAU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 N EARLHAM ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-2906
Mailing Address - Country:US
Mailing Address - Phone:619-549-3989
Mailing Address - Fax:
Practice Address - Street 1:18111 BROOKHURST ST STE 4300
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6728
Practice Address - Country:US
Practice Address - Phone:714-378-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA719888163WC0400X, 163WG0000X, 163WP2201X, 163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care