Healthcare Provider Details

I. General information

NPI: 1013820356
Provider Name (Legal Business Name): PICCS WITH GRACE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 SWINGSTONE DR
HEMET CA
92545-6125
US

IV. Provider business mailing address

5450 SWINGSTONE DR
HEMET CA
92545-6125
US

V. Phone/Fax

Practice location:
  • Phone: 951-438-0577
  • Fax:
Mailing address:
  • Phone: 951-438-0577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALONZO BURRELL
Title or Position: PICC RN
Credential: RN
Phone: 951-438-0577