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Organization
YOLANDA T GRADY, M.D. INC
Active
Organization
YOLANDA T GRADY, M.D. INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YOLANDA GRADY M.D. (PRESIDENT)
(909) 628-4205
Entity
Organization
Contact information
Practice address
13768 ROSWELL AVE, SUITE 202, CHINO, CA 91710-1401
(909) 628-4205
(909) 628-4875
Mailing address
13768 ROSWELL AVE, SUITE 202, CHINO, CA 91710-1401
(909) 628-4205
(909) 628-4875
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A536730
—
CA
01
—
P00418455
MEDICARE RAILROAD PTAN
CA
01
—
ZZZ31642Z
PTAN
CA
Enumeration date
10/04/2006
Last updated
05/29/2012
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