Healthcare Provider Details

I. General information

NPI: 1396675773
Provider Name (Legal Business Name): GRACE GRISELDA CHAVEZ SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22365 BARTON RD STE 104
GRAND TERRACE CA
92313-5037
US

IV. Provider business mailing address

17070 FRANKLAND LN
RIVERSIDE CA
92504-8928
US

V. Phone/Fax

Practice location:
  • Phone: 909-824-2899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number3833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: