Individual
GRACE SO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1625 STOCKTON BLVD STE 106, SACRAMENTO, CA 95816-7098
(916) 262-9002
Mailing address
PO BOX 255228, SACRAMENTO, CA 95865-5228
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A108392
CA
Other
Enumeration date
09/09/2009
Last updated
12/08/2023
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