Provider Demographics
NPI:1306495908
Name:GLOBAL GRACE MEDICAL SERVICES INC
Entity type:Organization
Organization Name:GLOBAL GRACE MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:OLUBUKOLA
Authorized Official - Last Name:ADEAGBO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:323-365-8154
Mailing Address - Street 1:2204 TORRANCE BLVD,
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-0502
Mailing Address - Country:US
Mailing Address - Phone:424-488-2030
Mailing Address - Fax:424-488-2202
Practice Address - Street 1:2204 TORRANCE BLVD,
Practice Address - Street 2:SUITE 102
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-0502
Practice Address - Country:US
Practice Address - Phone:424-488-2030
Practice Address - Fax:424-488-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty