Healthcare Provider Details

I. General information

NPI: 1417534710
Provider Name (Legal Business Name): GRACE MICHELLE KHOURY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9990 COUNTY FARM RD
RIVERSIDE CA
92503-3542
US

IV. Provider business mailing address

9990 COUNTY FARM RD
RIVERSIDE CA
92503-3542
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-4000
  • Fax:
Mailing address:
  • Phone: 951-486-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA202942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: