Individual
ADA DE GRACIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3204 PARK AVE, BRONX, NY 10451-4045
(404) 952-5513
Mailing address
3204 PARK AVE, BRONX, NY 10451-4045
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
768753
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
768753
—
NY
Enumeration date
08/06/2021
Last updated
08/06/2021
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