Provider Demographics
NPI:1306057633
Name:GRAEHL, JERI LYNNE (LAC MAOM)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:LYNNE
Last Name:GRAEHL
Suffix:
Gender:F
Credentials:LAC MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 GRAPEVINE DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-1578
Mailing Address - Country:US
Mailing Address - Phone:805-981-9491
Mailing Address - Fax:
Practice Address - Street 1:2502 GRAPEVINE DR
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-1578
Practice Address - Country:US
Practice Address - Phone:805-981-9491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8356171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist