Healthcare Provider Details

I. General information

NPI: 1619591989
Provider Name (Legal Business Name): JANEL GRACIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5823 YORK BLVD STE 1
LOS ANGELES CA
90042-2634
US

IV. Provider business mailing address

5823 YORK BLVD STE 3
LOS ANGELES CA
90042-2634
US

V. Phone/Fax

Practice location:
  • Phone: 323-255-1575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA184594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: