Healthcare Provider Details

I. General information

NPI: 1013736008
Provider Name (Legal Business Name): MARCELA DENISSE DE GRACIA RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 KUHN DR STE 110
CHULA VISTA CA
91914-3551
US

IV. Provider business mailing address

304 WELLINGTON PL
JACKSONVILLE NC
28546-8341
US

V. Phone/Fax

Practice location:
  • Phone: 619-864-7070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-383486
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: