Individual
LISA GRAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1312 E VAQUERO CT, CHULA VISTA, CA 91910-8134
(971) 222-6092
Mailing address
1312 E VAQUERO CT, CHULA VISTA, CA 91910-8134
(971) 222-6092
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H5443
OR
Other
Enumeration date
05/19/2011
Last updated
09/06/2024
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