Provider Demographics
NPI:1730213745
Name:GRABER, JASON (M D)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GRABER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S BEVERLY DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4426
Mailing Address - Country:US
Mailing Address - Phone:310-282-8838
Mailing Address - Fax:310-788-0431
Practice Address - Street 1:420 S BEVERLY DR
Practice Address - Street 2:SUITE 209
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4426
Practice Address - Country:US
Practice Address - Phone:310-282-8838
Practice Address - Fax:310-788-0431
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA613322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA61332OtherMEDICAL LICENSE