Provider Demographics
NPI:1851836894
Name:GRAVA, KIMBERLY ANN GERALDEZ (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY ANN
Middle Name:GERALDEZ
Last Name:GRAVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY ANN
Other - Middle Name:DE JESUS
Other - Last Name:GERALDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:201 S BUENA VISTA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4570
Mailing Address - Country:US
Mailing Address - Phone:818-525-5123
Mailing Address - Fax:
Practice Address - Street 1:201 S BUENA VISTA ST STE 100
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4570
Practice Address - Country:US
Practice Address - Phone:818-525-5123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005055363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology