Active NPI
Alonza C Graham
- Clinical Social Worker
- Perris, CA
National Provider Identifier
1053912857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 109870
- Practice address
- 450 E San Jacinto Ave
Perris, CA 92571-2833 - Phone
- (951) 715-5040
- NPI assigned
- Nov 6, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 109870 | CA | |
| Case Manager/Care Coordinator | 171M00000X | |||
| Clinical Social Worker | 1041C0700X | 109870 | CA | Primary |
Addresses
Primary practice location
450 E San Jacinto Ave
Perris, CA 92571-2833
Mailing address
450 E San Jacinto Ave
Perris, CA 92571-2833
Other practice location 1
14700 Manzanita Park Rd
Beaumont, CA 92223
Phone (951) 845-3155
Other practice location 2
22445 Alessandro Blvd # 113-114
Moreno Valley, CA 92553-8358
Phone (951) 788-8812
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109870 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691971200000",
"number": "1053912857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 E SAN JACINTO AVE",
"city": "PERRIS",
"state": "CA",
"postal_code": "925712833"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 E SAN JACINTO AVE",
"city": "PERRIS",
"state": "CA",
"postal_code": "925712833",
"telephone_number": "951-715-5040"
}
],
"practiceLocations": [
{
"address_1": "14700 Manzanita Park Rd",
"address_purpose": "LOCATION",
"city": "Beaumont",
"state": "CA",
"postal_code": "92223",
"country_code": "US",
"telephone_number": "951-845-3155",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "22445 Alessandro Blvd # 113-114",
"address_purpose": "LOCATION",
"city": "Moreno Valley",
"state": "CA",
"postal_code": "925538358",
"country_code": "US",
"telephone_number": "951-788-8812",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GRAHAM",
"first_name": "ALONZA",
"middle_name": "C",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-06",
"last_updated": "2023-08-14",
"certification_date": "2023-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "109870",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "109870",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Perris, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.