Individual
MINERVA GRADO-GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15190 SEGOVIA CT, SAN DIEGO, CA 92129-1219
(661) 378-2789
Mailing address
4202 43RD ST, SAN DIEGO, CA 92105-1202
(619) 549-9845
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A9702240
DRIVER LICENSE
CA
Enumeration date
09/01/2022
Last updated
09/01/2022
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