Provider Demographics
NPI:1043853732
Name:HUAYHUA, GRAMMY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:GRAMMY
Middle Name:
Last Name:HUAYHUA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19503 BLUFFWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2413
Mailing Address - Country:US
Mailing Address - Phone:951-295-1802
Mailing Address - Fax:
Practice Address - Street 1:19503 BLUFFWOOD ST
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2413
Practice Address - Country:US
Practice Address - Phone:951-295-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95011255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95011255Medicaid