Provider Demographics
NPI:1447865845
Name:DE GRAAF-GARCIA, LAUREL PATRICIA (CMT)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:PATRICIA
Last Name:DE GRAAF-GARCIA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 W WILSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1825
Mailing Address - Country:US
Mailing Address - Phone:714-267-0201
Mailing Address - Fax:
Practice Address - Street 1:1202 BRISTOL ST FL 2
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-8605
Practice Address - Country:US
Practice Address - Phone:714-424-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71378225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist