Provider Demographics
NPI:1417791625
Name:STCLAIR, GRACE MARGARITA
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MARGARITA
Last Name:STCLAIR
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 1:369 PARKFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-3085
Mailing Address - Country:US
Mailing Address - Phone:255-869-5039
Mailing Address - Fax:
Practice Address - Street 1:369 PARKFIELD WAY
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-3085
Practice Address - Country:US
Practice Address - Phone:925-586-9503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist