Individual
GRACE A BUONAVITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
436 S RIVERSIDE AVE, RIALTO, CA 92376-6523
(909) 877-8868
(909) 877-0008
Mailing address
436 S RIVERSIDE AVE, RIALTO, CA 92376-6523
(909) 877-8868
(909) 877-0008
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA13592
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA13592
MEDICAL LICENSE
—
Enumeration date
12/11/2006
Last updated
03/07/2023
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