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General NPI Number Information
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NPI Number | 1649141474
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Entity Type | Organization
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Legal Business Name | NU GRACE MEDICAL SUPPLY LLC
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 11799 SEBASTIAN WAY STE 103
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0708
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Country | US
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Telephone | 909-289-0508
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Fax | 909-751-0079
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Provider Business Mailing Address
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Address Line | 11799 SEBASTIAN WAY STE 103
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0708
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Country | US
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Telephone | 909-289-0508
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Fax | 909-751-0079
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Authorized Official
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Title or Position | CEO
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Name | GEORGINA FLOYD
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Credential | DNP
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Telephone | 909-637-6520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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