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NPI Code Detail

MEDICARE: DR. GRACE BOMMARITO DO

MEDICARE: DR. GRACE BOMMARITO DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology PhysicianDO3384NV

General Provider Information

NPI Number : 1184282626
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GRACE BOMMARITO DO
Provider Business Mailing Address
First Line : 9970 W CHEYENNE AVE STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-7700
Country : US
Telephone Number : 702-978-8900
Fax Number : 702-978-7617
Provider Business Practice Location Address
First Line : 9970 W CHEYENNE AVE STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-7700
Country : US
Telephone Number : 702-978-8900
Fax Number : 702-978-7617
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2019
Last Update Date : 12/01/2025

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Directions to “ DR. GRACE BOMMARITO DO” Practice Location

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