# OUR LADY OF GRACE MEDICAL CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356474647
- **Authorized official:** DR. CARLOS F VERA MD (CEO)
- **Authorized official phone:** (303) 531-5181

## Contact information

- **Practice address:** 992 W 104TH AVE, NORTHGLENN, CO 80234-3801
- **Practice address phone:** (303) 531-5181
- **Practice address fax:** (303) 531-5185
- **Mailing address:** PO BOX 350968, WESTMINSTER, CO 80035-0968
- **Mailing address phone:** (303) 531-5181
- **Mailing address fax:** (303) 531-5185

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/14/2007
- **Last updated:** 03/04/2008