Provider Demographics
NPI:1184861866
Name:HAGOPIAN, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HAGOPIAN
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 1:597 CENTER AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4640
Mailing Address - Country:US
Mailing Address - Phone:925-313-6250
Mailing Address - Fax:925-313-6188
Practice Address - Street 1:597 CENTER AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4640
Practice Address - Country:US
Practice Address - Phone:925-313-6250
Practice Address - Fax:925-313-6188
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA214738163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management