Healthcare Provider Details

I. General information

NPI: 1962322842
Provider Name (Legal Business Name): GRACE MACAPAGAL GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 S 2ND AVE
COVINA CA
91723-3013
US

IV. Provider business mailing address

477 GENDEL DR
LA PUENTE CA
91744-6168
US

V. Phone/Fax

Practice location:
  • Phone: 626-214-1480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number739175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: