Individual
JUAN ANGEL GRACIANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
3940 HOME AVE, SAN DIEGO, CA 92105-5952
(619) 262-8000
(619) 266-7405
Mailing address
848 COLORADO AVE APT A, CHULA VISTA, CA 91911-8143
(619) 934-1774
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
269870
CA
Other
Enumeration date
05/07/2013
Last updated
05/07/2013
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