Provider Demographics
NPI:1043621444
Name:GRASSO, MINA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MINA
Middle Name:
Last Name:GRASSO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MINA
Other - Middle Name:
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1113 ALTA AVE STE 210
Mailing Address - Street 2:UPLAND
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2803
Mailing Address - Country:US
Mailing Address - Phone:909-982-1074
Mailing Address - Fax:909-982-3104
Practice Address - Street 1:1113 ALTA AVE STE 210
Practice Address - Street 2:UPLAND
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2803
Practice Address - Country:US
Practice Address - Phone:909-982-1074
Practice Address - Fax:909-982-3104
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN350791363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily