Provider Demographics
NPI:1891998159
Name:GRAGEDA, MARIE CLAUDETTE DECASTRO (MD)
Entity type:Individual
Prefix:
First Name:MARIE CLAUDETTE
Middle Name:DECASTRO
Last Name:GRAGEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 SUNNYSLOPE RD STE E3
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5638
Mailing Address - Country:US
Mailing Address - Phone:831-636-7494
Mailing Address - Fax:831-636-7496
Practice Address - Street 1:930 SUNNYSLOPE RD STE E3
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5638
Practice Address - Country:US
Practice Address - Phone:831-636-7494
Practice Address - Fax:831-636-7496
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine