Individual
GRACE BASCOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5145 N CALIFORNIA AVE, CHICAGO, IL 60625-3661
(773) 878-8200
Mailing address
5145 N CALIFORNIA AVE, CHICAGO, IL 60625-3661
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085011345
IL
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085011345
085011345
IL
Enumeration date
03/27/2025
Last updated
03/19/2026
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