Healthcare Provider Details

I. General information

NPI: 1750101564
Provider Name (Legal Business Name): GRACE SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 WILSHIRE BLVD STE 415
BEVERLY HILLS CA
90211-1953
US

IV. Provider business mailing address

8929 WILSHIRE BLVD STE 400
BEVERLY HILLS CA
90211-1953
US

V. Phone/Fax

Practice location:
  • Phone: 609-575-7225
  • Fax:
Mailing address:
  • Phone: 609-575-7225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM JAMES RAHAL
Title or Position: OWNER
Credential: MD
Phone: 609-575-7225