Individual
ERICA RENE GRAHAM-BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3656 GINGER ST, PERRIS, CA 92571-7825
(818) 818-1817
Mailing address
3656 GINGER ST, PERRIS, CA 92571-7825
(818) 818-1817
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
331881331
CA
Other
Enumeration date
10/25/2023
Last updated
10/25/2023
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