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General NPI Number Information
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NPI Number | 1508400219
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Entity Type | Organization
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Legal Business Name | GRACE OROPESA LLC
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Dates
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Enumeration Date | 11/05/2019
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 12824 NW 21ST ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2534
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Country | US
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Telephone | 954-918-2820
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Fax |
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Provider Business Mailing Address
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Address Line | 12824 NW 21ST ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2534
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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 | OWNER
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Name | GRAZIQ OROPESA
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Credential | ARNP
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Telephone | 954-918-2820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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