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Organization
GRACEVINE HEALTHCARE SVCS A PROFESSNAL NURSING CORP
Active
Organization
GRACEVINE HEALTHCARE SVCS A PROFESSNAL NURSING CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLUWAYEMISI DARAMOLA (OWNER)
(909) 743-1300
Entity
Organization
Contact information
Practice address
473 E CARNEGIE DR STE 200, SAN BERNARDINO, CA 92408-4201
(909) 743-1300
Mailing address
473 E CARNEGIE DR, STE 200, SAN BERNARDINO, CA 92408
(909) 743-1300
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/24/2022
Last updated
05/27/2025
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