Healthcare Provider Details

I. General information

NPI: 1437139060
Provider Name (Legal Business Name): ANITA JEANNE MOON-GRADY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANITA GRADY M.D.

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 STOCKTON BLVD
SACRAMENTO CA
95817-2208
US

IV. Provider business mailing address

2516 STOCKTON BLVD
SACRAMENTO CA
95817-2208
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5470
  • Fax: 916-734-0424
Mailing address:
  • Phone: 916-734-5470
  • Fax: 916-734-0424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberG079633
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberG079633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: