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General NPI Number Information
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NPI Number | 1447046883
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Entity Type | Organization
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Legal Business Name | GRACE MOBILE MEDICAL GROUP
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 17315 STUDEBAKER RD STE 204
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City | CERRITOS
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State | CA
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Zip | 90703-2508
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Country | US
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Telephone | 310-295-6492
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Fax | 310-295-6542
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Provider Business Mailing Address
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Address Line | 17315 STUDEBAKER RD STE 204
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City | CERRITOS
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State | CA
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Zip | 90703-2508
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Country | US
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Telephone | 310-295-6492
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Fax | 310-295-6542
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Authorized Official
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Title or Position | CEO
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Name | MR. ROLAND T FLORES
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Credential | RN
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Telephone | 310-245-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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