Healthcare Provider Details

I. General information

NPI: 1821236704
Provider Name (Legal Business Name): GERALD JUNIOR GRACIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 DOLBEER ST
EUREKA CA
95501-4736
US

IV. Provider business mailing address

1311 W 5TH ST APT 110
LOS ANGELES CA
90017-4921
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-8121
  • Fax:
Mailing address:
  • Phone: 305-710-9041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberA108980
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number267318
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: