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General NPI Number Information
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NPI Number | 1235969452
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Entity Type | Individual
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Provider Name | MARY GRACE LEAL GUARDIANO
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Gender | Female
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Dates
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Enumeration Date | 08/02/2024
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 1451 28TH AVE
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City | OAKLAND
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State | CA
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Zip | 94601-1632
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Country | US
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Telephone | 510-261-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 1130 PARK AVE APT C
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City | ALAMEDA
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State | CA
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Zip | 94501-5265
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 633490
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License Number State | CA
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