Provider Demographics
NPI:1407476179
Name:VENEZIA, GRACE MARCY ANYA (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:MARCY ANYA
Last Name:VENEZIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02537-1233
Mailing Address - Country:US
Mailing Address - Phone:339-237-2663
Mailing Address - Fax:
Practice Address - Street 1:1101 VAN NESS AVE STE 1120
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6919
Practice Address - Country:US
Practice Address - Phone:415-600-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program