MEDICARE: DR. AMANDA GRACIA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	21200	NV

General Provider Information

NPI Number	:	1295232791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA GRACIA MD

Provider Business Mailing Address
First Line	:	2831 BUSINESS PARK CT STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9010
Country	:	US
Telephone Number	:	702-844-8143
Fax Number	:	702-844-8145

Provider Business Practice Location Address
First Line	:	2831 BUSINESS PARK CT STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9010
Country	:	US
Telephone Number	:	702-844-8143
Fax Number	:	702-844-8145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2018
Last Update Date	:	01/03/2023

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Directions to “ DR. AMANDA GRACIA MD” Practice Location

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