Healthcare Provider Details

I. General information

NPI: 1679989651
Provider Name (Legal Business Name): GRACE TRIEU VETTRAINO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7740 EL CAMINO REAL STE F
CARLSBAD CA
92009-8514
US

IV. Provider business mailing address

1 EMBARCADERO CTR STE 1900
SAN FRANCISCO CA
94111-3723
US

V. Phone/Fax

Practice location:
  • Phone: 619-232-3500
  • Fax: 415-252-7176
Mailing address:
  • Phone: 415-658-6791
  • Fax: 408-228-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number674191-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95002441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: