Basic Information
| Provider Information | |||||||||
| NPI: | 1396346789 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDEN-GRAVES | ||||||||
| FirstName: | CHRISTINE | ||||||||
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| Credential: | DR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2668 ROGUE RIVER CIR | ||||||||
| Address2: | |||||||||
| City: | WEST SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956914921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158677842 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2540 CARMICHAEL WAY | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956085314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164820465 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2020 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 299000 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.