Healthcare Provider Details

I. General information

NPI: 1093314361
Provider Name (Legal Business Name): GRACE ALFEREZ ESPIRITU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 REDWOOD ST
VALLEJO CA
94590-2955
US

IV. Provider business mailing address

8356 DELICATO WAY
SACRAMENTO CA
95829-9231
US

V. Phone/Fax

Practice location:
  • Phone: 707-557-6948
  • Fax:
Mailing address:
  • Phone: 916-346-3834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH81966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: