Healthcare Provider Details

I. General information

NPI: 1003188137
Provider Name (Legal Business Name): HOPE & GRACE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 N HOMESTEAD BLVD SUITE 104
HOMESTEAD FL
33030-6207
US

IV. Provider business mailing address

698 N HOMESTEAD BLVD SUITE 104
HOMESTEAD FL
33030-6207
US

V. Phone/Fax

Practice location:
  • Phone: 305-245-3534
  • Fax:
Mailing address:
  • Phone: 305-245-3534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA M RUIZ-ACEVEDO
Title or Position: PRESIDENT/DIRECTOR
Credential: MD
Phone: 305-245-3534