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General NPI Number Information
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NPI Number | 1659306447
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Entity Type | Individual
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Provider Name | GRACE CHERRY NP
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Gender | Female
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 06/09/2010
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Provider Practice Location Address
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Address Line | 200 MEDICAL PLZ #365,214,420,120,510
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City | LOS ANGELES
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State | CA
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Zip | 90095-3075
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Country | US
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Telephone | 310-794-1092
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone | 310-794-1092
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 15069
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 424933
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 15069
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License Number State | CA
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