Individual
GRACE FERMINA DE LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN-BC, BSN
Contact information
Practice address
11201 BENTON ST, LOMA LINDA, CA 92357-1000
(909) 825-7084
Mailing address
707 PANTERA DR, DIAMOND BAR, CA 91765-1893
(909) 800-6821
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
847841
CA
Other
Enumeration date
08/29/2019
Last updated
08/29/2019
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