MEDICARE: GRACE E USIGBE

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
1	174400000X	Specialist	5374550001	CA
2	106H00000X	Marriage & Family Therapist	113268	CA

General Provider Information

NPI Number	:	1639110414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE E USIGBE

Provider Business Mailing Address
First Line	:	PO BOX 71170
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92513-1170
Country	:	US
Telephone Number	:	951-237-6524
Fax Number	:

Provider Business Practice Location Address
First Line	:	4262 LAKEFALL CT
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92505-3459
Country	:	US
Telephone Number	:	951-237-6524
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	02/18/2021

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Directions to “ GRACE E USIGBE ” Practice Location

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