Provider Demographics
NPI:1215498167
Name:GRACIA, EUFEMIA
Entity type:Individual
Prefix:
First Name:EUFEMIA
Middle Name:
Last Name:GRACIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 S CLOVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-2121
Mailing Address - Country:US
Mailing Address - Phone:310-507-3704
Mailing Address - Fax:
Practice Address - Street 1:2346 S CLOVERDALE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-2121
Practice Address - Country:US
Practice Address - Phone:310-507-3704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36234126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant