Individual
GRACE HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5542 PALO VERDE ST, MONTCLAIR, CA 91763-2538
(909) 252-8170
Mailing address
5542 PALO VERDE ST, MONTCLAIR, CA 91763-2538
(909) 252-8170
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
RDA53687
CA
Other
Enumeration date
03/20/2017
Last updated
03/20/2017
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