Individual
GRACE OH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14775 JEFFREY RD STE C, IRVINE, CA 92618-0402
(661) 505-3260
Mailing address
3721 PROVINCETOWN AVE, IRVINE, CA 92606-1727
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/28/2023
Last updated
05/15/2024
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