Individual
GRACE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12401 WASHINGTON BLVD, WHITTIER, CA 90602-1006
(562) 698-0811
Mailing address
1912 S JACARANDA ST UNIT 417, ANAHEIM, CA 92805-8744
(714) 401-3034
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
1639707573
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/27/2020
Last updated
06/27/2024
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