Provider Demographics
NPI:1215965223
Name:GRACE MEDICAL GROUP OF THE VALLEY INC
Entity type:Organization
Organization Name:GRACE MEDICAL GROUP OF THE VALLEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:ENDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-392-3230
Mailing Address - Street 1:PO BOX 1628
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711
Mailing Address - Country:US
Mailing Address - Phone:909-392-3230
Mailing Address - Fax:909-392-3224
Practice Address - Street 1:2740 N GAREY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1800
Practice Address - Country:US
Practice Address - Phone:909-392-3230
Practice Address - Fax:909-392-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty