Healthcare Provider Details

I. General information

NPI: 1912120312
Provider Name (Legal Business Name): MRS. KARRIE JANE GRACIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7080 N MARKS AVE 104
FRESNO CA
93711-0288
US

IV. Provider business mailing address

3523 HORNET AVE
CLOVIS CA
93611-5550
US

V. Phone/Fax

Practice location:
  • Phone: 559-248-8550
  • Fax:
Mailing address:
  • Phone: 559-292-0574
  • Fax: 559-346-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: