=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265604631
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRACE AYENSU DANQUAH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2008
-----------------------------------------------------
Last Update Date | 06/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 S 7TH AVE SUITE C
-----------------------------------------------------
City | BARSTOW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92311-3056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-256-1414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 S 7TH AVE SUITE C
-----------------------------------------------------
City | BARSTOW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92311-3056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-450-4544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GRACE AYENSU-DANQUAH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 909-450-4544
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | A97084
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------