Provider Demographics
NPI:1730529322
Name:GRAUE, DIANA NICOLE (LAC, CMT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:NICOLE
Last Name:GRAUE
Suffix:
Gender:F
Credentials:LAC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 PAGE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2020
Mailing Address - Country:US
Mailing Address - Phone:510-332-0060
Mailing Address - Fax:
Practice Address - Street 1:350 SANSOME ST STE 730
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-1312
Practice Address - Country:US
Practice Address - Phone:415-890-5583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15426171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist