Healthcare Provider Details

I. General information

NPI: 1043659337
Provider Name (Legal Business Name): GRACE MARIE HECKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 ORANGE TREE LN STE 344
REDLANDS CA
92374-4500
US

IV. Provider business mailing address

1600 PROVIDENCE DR
WACO TX
76707-2261
US

V. Phone/Fax

Practice location:
  • Phone: 909-792-1388
  • Fax: 97-487-9259
Mailing address:
  • Phone: 254-313-4200
  • Fax: 254-313-4326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA168371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: