Provider Demographics
NPI:1235409715
Name:GRADILLA, VIRGINIA NAVA (CNA)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:NAVA
Last Name:GRADILLA
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 N STATE ST
Mailing Address - Street 2:UNIT A413
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-6313
Mailing Address - Country:US
Mailing Address - Phone:951-795-9575
Mailing Address - Fax:
Practice Address - Street 1:1281 N STATE ST
Practice Address - Street 2:UNIT A413
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-6313
Practice Address - Country:US
Practice Address - Phone:951-795-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00797325374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide